Heuman et al identified predictors of early death for a patient with cirrhosis. These can help to identify a patient who may benefit from more aggressive management including early transplant. The authors are from Virginia Commonwealth University and the McGuire Department of Veterans Affairs Medical Center in Richmond.
Patient selection: cirrhosis
Outcome: early death (death within 180 days without transplant)
Predictors for early mortality:
(1) MELD score
(2) refractory/persistent ascites
(3) hyponatremia (serum sodium < 135 mmol/L)
If the MELD is < 21, then prognosis is determined by persistent ascites and hyponatremia.
If the MELD is >= 21, then the prognosis is determined by the MELD score.
Parameters
Finding
Points
persistent ascites
absent
0
present
4.46
hyponatremia
absent
0
present
4.53
MELD-ascites-sodium = MELD-AS =
= (MELD) + (points for ascites) + (points for sodium)
Performance:
• The area under the ROC curve for training and validation groups combined is 0.81.
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