MELD scores with incorporation of serum sodium and death prediction in cirrhotic patients on the waiting list for liver transplantation: a single center experience in southern Brazil

To compare the accuracy of standard model for end‐stage liver disease (MELD) score with that of four MELD‐based scores incorporating serum sodium (SNa) to predict three‐ and six‐month mortality in cirrhotic patients after their placement on the waiting list for liver transplantation (LT). A cohort study was performed. Receiver operating characteristic (ROC) curves were generated for MELD, MELD incorporating SNa (MELD‐Na, MELD‐Na2), integrated MELD (iMELD), and MELD to SNa ratio (MESO) index to assess the predictive accuracy of these scores to determine three‐ and six‐month mortality. The c‐statistic (area under the ROC curve [AUC]) was used to determine predictive power and the Cox proportional‐hazard ratio to estimate death risk. We studied 558 patients. There was a statistically significant difference in the predictive accuracy of scores at three months (AUCs: MELD = 0.79 [95% CI = 0.72–0.87]; MELD‐Na = 0.84 [95% CI = 0.78–0.90]; MELD‐Na2 = 0.85 [95% CI = 0.80–0.91]; iMELD = 0.85 [95% CI = 0.80–0.90]; MESO = 0.81 [95% CI = 0.80–0.91]) and at six months (MELD = 0.73 [95% CI = 0.67–0.80]; MELD‐Na = 0.79 [95% CI = 0.73–0.84]; MELD‐Na2 = 0.80 [95% CI = 0.74–0.85]; iMELD = 0.80 [95% CI = 0.75–0.85]; MESO = 0.75 [95% CI = 0.69–0.81]) (p