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. 2009 Sep 25:9:72.
doi: 10.1186/1471-230X-9-72.

Limitations of the MELD score in predicting mortality or need for removal from waiting list in patients awaiting liver transplantation

Daniel Gotthardt  1 , Karl Heinz Weiss, Melanie Baumgärtner, Alexandra Zahn, Wolfgang Stremmel, Jan Schmidt, Thomas Bruckner, Peter Sauer
Affiliations

Limitations of the MELD score in predicting mortality or need for removal from waiting list in patients awaiting liver transplantation

Daniel Gotthardt et al. BMC Gastroenterol. .

Abstract

Background: Decompensated cirrhosis is associated with a poor prognosis and liver transplantation provides the only curative treatment option with excellent long-term results. The relative shortage of organ donors renders the allocation algorithms of organs essential. The optimal strategy based on scoring systems and/or waiting time is still under debate.

Methods: Data sets of 268 consecutive patients listed for single-organ liver transplantation for nonfulminant liver disease between 2003 and 2005 were included into the study. The Model for End-Stage Liver Disease (MELD) and Child-Turcotte-Pugh (CTP) scores of all patients at the time of listing were used for calculation. The predictive ability not only for mortality on the waiting list but also for the need for withdrawal from the waiting list was calculated for both scores. The Mann-Whitney-U Test was used for the univariate analysis and the AUC-Model for discrimination of the scores.

Results: In the univariate analysis comparing patients who are still on the waiting list and patients who died or were removed from the waiting list due to poor conditions, the serum albumin, bilirubin INR, and CTP and MELD scores as well as the presence of ascites and encephalopathy were significantly different between the groups (p < 0.05), whereas serum creatinine and urea showed no difference. Comparing the predictive abilities of CTP and MELD scores, the best discrimination between patients still alive on the waiting list and patients who died on or were removed from the waiting list was achieved at a CTP score of >or=9 and a MELD score of >or=14.4. The sensitivity and specificity to identify mortality or severe deterioration for CTP was 69.0% and 70.5%, respectively; for MELD, it was 62.1% and 72.7%, respectively. This result was supported by the AUC analysis showing a strong trend for superiority of CTP over MELD scores (AUROC 0.73 and 0.68, resp.; p = 0.091).

Conclusion: The long term prediction of mortality or removal from waiting list in patients awaiting liver transplantation might be better assessed by the CTP score than the MELD score. This might have implications for the development of new improved scoring systems.

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Figures

Figure 1
Figure 1
The errors bars are shown for the discrimination of patients by CTP (A) and MELD (B) scores revealing a better cutoff for CTP.
Figure 2
Figure 2
The ROC curve shows the performance of the CTP score (AUROC 0.73) compared to the MELD score (AUROC 0.68).
See this image and copyright information in PMC

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