A COMPARATIVE STUDY OF MODEL FOR END-STAGE LIVER DISEASE- SODIUM (MELD- NA) VS. MODEL FOR END-STAGE LIVER DISEASE (MELD) IN PREDICTING SHORT-TERM MORTALITY IN DECOMPENSATED LIVER DISEASE.
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Keywords
Model for end-stage liver disease (MELD), MELD Na, prediction model, cirrhosis of liver, complications, mortality.
Abstract
: In cirrhotic individuals with ascites, dilutional hyponatremia is a commonly observed occurrence that is linked to increased mortality rates during hospitalisation. Model for end-stage liver disease (MELD) is a highly reliable indicator of 3-month mortality in cirrhotic patients who are scheduled for orthotopic liver transplantation. Additionally, the study aimed to determine if incorporating serum sodium into the MELD would enhance the accuracy of the score used to estimate waitlist mortality.
Methodology: A comparative study was done in 100 patients on two prediction modalities (MELD and MELD Na) in patients with cirrhosis of liver in department of general medicine over a period of 24 months. After obtaining permission from the institutional ethics committee, informed consent will be taken from the patient and their attendees. A semistructured case proforma was used to collect the data. History and clinical examination will be done and relevant laboratory tests will be performed. Based on the serum sodium values, patients are divided into three groups. Group A - Sr sodium > 135, Group B – Sr sodium 131 - 135 and Group C – Sr sodium < 130. The presence of complications and its frequency in all 3 groups were studied and analysed. Statistical analysis was done using SPSS, Med calc is used for the calculation of predictive accuracy statistics of MELD and MELD – Na values.
Results: Overall, alcohol-related liver disease was the leading cause across all groups, followed by viral hepatitis and other causes, with a progressive decline in total cases from Group A (40) to Group C (28). while age and gender were comparable among groups, disease severity as reflected by MELD and MELD-Na scores increased significantly from Group A to Group C thus showing the association with hyponatraemia. Hepatic encephalopathy, hepatorenal syndrome, spontaneous bacterial peritonitis, variceal bleeding, and mortality at 3 months were analyzed as complications of liver cirrhosis across the three groups. The frequency and severity of complications increased significantly from Group A to Group C, indicating a clear association between disease progression and adverse outcomes. In predicting mortality MELD-Na achieved greater accuracy (87.92%) than MELD (75.83%).
Conclusions: Incorporation of serum sodium in prediction models accounts for the detrimental effects of dilutional hyponatraemia, a recognized marker of circulatory dysfunction and poor prognosis in cirrhosis.
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Dr.Saritha kalyanam
MBBS MD, Associate professor, Department of General medicine, Osmania medical college, Hyderabad, Telangana, India.
Dr. Kannekanti Murali Krishna
2MBBS MD, Associate professor, Department of General medicine, Government medical college, Siddipet, Telangana, India.
Dr. M .Sai kiran kumar
MBBS MD, Senior Resident, Department of General medicine, Osmania medical college, Hyderabad, Telangana, India.
kathi Sruthi
Medical student, MBBS 3rd year, RVM medical college, siddipet, telangana India.