Londoño Maria-Carlota, Cárdenas Andrés, Guevara Mónica, Quintó Llorenç, de Las Heras Dara, Navasa Miguel, Rimola Antoni, Garcia-Valdecasas Juan-Carlos, Arroyo Vicente, Ginès Pere
Liver Unit, Hospital Clínic, Universitat de Barcelona, Institut de Investigacions Biomèdiques August Pi-Sunyer, CIBER de Enfermedades Hepáticas y Digestivas and Centro de Investigaciones Biomédicas Esther Koplowitz, Barcelona, Spain.
Gut. 2007 Sep;56(9):1283-90. doi: 10.1136/gut.2006.102764. Epub 2007 Apr 23.
BACKGROUND/AIMS: Serum sodium predicts prognosis in cirrhosis and may improve the prognostic accuracy of the model for end-stage liver disease (MELD) score, but the available information is limited. The aim of the present study was to assess the prognostic value of serum sodium in the prediction of survival at 3 and 12 months after listing in patients with cirrhosis awaiting liver transplantation, and to compare its predictive value with that of the MELD score.
308 consecutive patients with cirrhosis listed for transplantation during a 5-year period were included in the study. The end-point was survival at 3 and 12 months before transplantation. Variables obtained at the time of listing were analysed for prognostic value using multivariable analysis. Accuracy of prognostic variables was analysed by receiver operating characteristic (ROC) curves.
The MELD score and serum sodium concentration were the only independent predictors of survival at 3 and 12 months after listing. Low serum sodium was associated with an increased risk of death in all subpopulations of patients with cirrhosis categorised according to the major complication developed before listing. The area under the ROC curves for serum sodium and MELD score was not significantly different both at 3 months (0.83 vs 0.79, respectively) and at 12 months (0.70 vs 0.77, respectively). The addition of serum sodium did not significantly improve the accuracy of the MELD score in the prediction of survival at 3 and 12 months.
In patients with cirrhosis awaiting liver transplantation, serum sodium and MELD were found to be independent predictors of survival. Larger studies are needed to determine whether the addition of serum sodium to MELD can improve its prognostic accuracy.
背景/目的：血清钠可预测肝硬化患者的预后，可能提高终末期肝病模型（MELD）评分的预后准确性，但现有信息有限。本研究的目的是评估血清钠在预测肝硬化等待肝移植患者列入名单后3个月和12个月生存率方面的预后价值，并将其预测价值与MELD评分进行比较。
本研究纳入了5年期间连续列入移植名单的308例肝硬化患者。终点是移植前3个月和12个月的生存率。使用多变量分析对列入名单时获得的变量进行预后价值分析。通过受试者工作特征（ROC）曲线分析预后变量的准确性。
MELD评分和血清钠浓度是列入名单后3个月和12个月生存率的唯一独立预测因素。血清钠水平低与根据列入名单前发生的主要并发症分类的所有肝硬化患者亚组的死亡风险增加相关。血清钠和MELD评分的ROC曲线下面积在3个月时（分别为0.83和0.79）和12个月时（分别为0.70和0.77）无显著差异。添加血清钠并未显著提高MELD评分在预测3个月和12个月生存率方面的准确性。
在肝硬化等待肝移植患者中，血清钠和MELD被发现是生存率的独立预测因素。需要更大规模的研究来确定在MELD中添加血清钠是否能提高其预后准确性。
