Is an estimated glomerular filtration rate better than creatinine to be incorporated into the end-stage liver disease score?

• Published in: World journal of hepatology 2012-11, Vol.4 (11), p.291-298
• Main Authors: Chen, Yu-Wei, Chang, Ching-Wei, Chang, Chen-Wang, Wang, Tsang-En, Wu, Chih-Jen, Chen, Han-Hsiang
• Format: Article
• Language: English
• Subjects: cirrhosis; diet; disease; Endstage; Estimated; filtration; function; glomerular; Liver; Modification; Original; rate; renal
• ISSN: 1948-5182; 1948-5182
• DOI: 10.4254/wjh.v4.i11.291

AIM: To incorporate estimated glomerular filtrationrate (eGFR) into the model for end-stage liver disease(MELD) score to evaluate the predictive value.METHODS: From January 2004 to October 2008,the records of 4127 admitted cirrhotic patients were reviewed. Patients who survived and were followed up as outpatients were defined as survivors and theirmost recent available laboratory data were collected.Patients whose records indicated death at any time during the hospital stay were defined as non-survivors(in-hospital mortality). Patients with incomplete dataor with cirrhosis due to a congenital abnormality suchas primary biliary cirrhosis were excluded; thus, a totalof 3857 patients were enrolled in the present study.The eGFR, which was calculated by using either the modification of diet in renal disease (MDRD) equationor the chronic kidney disease epidemiology collaboration (CKD-EPI) equation, was incorporated into the MELD score after adjustment with the original MELDequation by logistic regression analysis [bilirubin and international normalized ratio (INR) were set at 1.0 forvalues less than 1.0].RESULTS: Patients defined as survivors were significantly younger, had a lower incidence of hepatoma,lower Child-Pugh and MELD scores, and better renalfunction. The underlying causes of cirrhosis werevery different from those in Western countries. In Tai-wan, most cirrhotic patients were associated with thehepatitis virus, especially hepatitis B. There were 16parameters included in univariate logistic regressionanalysis to predict in-hospital mortality and those with significant predicting values were included in furthermultivariate analysis. Both 4-variable MDRD eGFR and6-variable MDRD eGFR, rather than creatinine, weresignificant predictors of in-hospital mortality. Threenew equations were constructed (MELD-MDRD-4,MELD-MDRD-6, MELD-CKD-EPI). As expected, originalMELD score was a significant predictor of in-hospitalmortality (odds ratio = 1.25, P < 0.001). MELD-MDRD-4 excluded serum creatinine, with the coeffi-cients refit among the remaining 3 variables, i.e., totalbilirubin, INR and 4-variable MDRD eGFR. This model represented an exacerbated outcome over MELD score,as suggested by a decrease in chi-square (2161.45 vs2198.32) and an increase in -2 log (likelihood) (2810.77vs 2773.90). MELD-MDRD-6 included 6-variable MDRDeGFR as one of the variables and showed an improvement over MELD score, as suggested by an increasein chi-square (2293.82 vs 2198.32) and a