Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Aug;52(3):492-499.
doi: 10.1111/apt.15882. Epub 2020 Jun 23.

MELD remains the best predictor of mortality in outpatients with cirrhosis and severe ascites

Peter Jepsen  1   2 , Hugh Watson  1   3 , Stewart Macdonald  4 , Hendrik Vilstrup  1 , Rajiv Jalan  4
Affiliations

MELD remains the best predictor of mortality in outpatients with cirrhosis and severe ascites

Peter Jepsen et al. Aliment Pharmacol Ther. 2020 Aug.

Abstract

Background: The Model for Endstage Liver Disease (MELD) score may put patients with severe ascites at a disadvantage because they often have a poor quality of life and high mortality despite a favourable MELD score.

Aim: To develop a model that is better than the MELD score at predicting 1-year mortality among patients with cirrhosis, severe ascites and MELD ≤18.

Methods: We used data from a randomised trial (SPARe-1) of patients with cirrhosis and severe ascites to develop a model to predict 1-year mortality. We used stepwise backward elimination and Cox regression to identify the strongest predictors. Performance was assessed with the C index and the Brier score. We examined performance in an external cohort of trial participants with cirrhosis and severe ascites (SPARe-2 participants).

Results: We included 308 patients with a 1-year mortality of 20.4%. The final prediction model (Severe Ascites Mortality score, "SAM score") included four variables: serum bilirubin, serum sodium, history of SBP (yes or no) and diabetes (yes or no). No indicators of quality of life were included. After correction for optimism bias, the SAM and MELD scores had nearly identical predictive ability. The external validation cohort included 149 patients whose 1-year mortality was 22.4%. The MELD score performed marginally better in this cohort, partly because the effects of SBP and diabetes on mortality were much smaller in this cohort.

Conclusion: We did not succeed in developing a prediction model that was superior to the MELD score among patients with cirrhosis and severe ascites.

PubMed Disclaimer

Comment in

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

REFERENCES

    1. Heuman DM, Abou-Assi SG, Habib A, et al. Persistent ascites and low serum sodium identify patients with cirrhosis and low MELD scores who are at high risk for early death. Hepatology. 2004;40:802-810.
    1. Somsouk M, Kornfield R, Vittinghoff E, Inadomi JM, Biggins SW. Moderate ascites identifies patients with low model for end-stage liver disease scores awaiting liver transplantation who have a high mortality risk. Liver Transpl. 2011;17:129-136.
    1. Biggins SW, Colquhoun S, Gish RG, Runyon BA. Model for end-stage liver disease (MELD) exception for ascites. Liver Transpl. 2006;12:S88-90.
    1. Atiemo K, Skaro A, Maddur H, et al. Mortality risk factors among patients with cirrhosis and a low model for end-stage liver disease sodium score (≤15): An analysis of liver transplant allocation policy using aggregated electronic health record data. Am J Transplant. 2017;17:2410-2419.
    1. United Network for Organ Sharing. Clerical changes for implementation of adding serum sodium to the MELD score. https://optn.transplant.hrsa.gov/media/1575/policynotice_20151101.pdf. Accessed 8 April 2020.

LinkOut - more resources