Hyponatremia and Mortality among Patients on the Liver-Transplant Waiting List

By W. R. Kim, S. Biggins, Walter K. Kremers, R. Wiesner, Patrick S. Kamath, J. Benson, E. Edwards, Terry M. Therneau. New England Journal of Medicine, 2008

1,327 citations recorded by the source corpus.

BACKGROUND Under the current liver-transplantation policy, donor organs are offered to patients with the highest risk of death. METHODS Using data derived from all adult candidates for primary liver transplantation who were registered with the Organ Procurement and Transplantation Network in 2005 and 2006, we developed and validated a multivariable survival model to predict mortality at 90 days after registration. The predictor variable was the Model for End-Stage Liver Disease (MELD) score with and without the addition of the serum sodium concentration. The MELD score (on a scale of 6 to 40, with higher values indicating more severe disease) is calculated on the basis of the serum bilirubin and creatinine concentrations and the international normalized ratio for the prothrombin time. RESULTS In 2005, there were 6769 registrants, including 1781 who underwent liver transplantation and 422 who died within 90 days after registration on the waiting list. Both the MELD score and the serum sodium concentration were significantly associated with mortality (hazard ratio for death, 1.21 per MELD point and 1.05 per 1-unit decrease in the serum sodium concentration for values between 125 and 140 mmol per liter; P<0.001 for both variables). Furthermore, a significant interaction was found between the MELD score and the serum sodium concentration, indicating that the effect of the serum sodium concentration was greater in patients with a low MELD score. When applied to the data from 2006, when 477 patients died within 3 months after registration on the waiting list, the combination of the MELD score and the serum sodium concentration was considerably higher than the MELD score alone in 32 patients who died (7%). Thus, assignment of priority according to the MELD score combined with the serum sodium concentration might have resulted in transplantation and prevented death. CONCLUSIONS This population-wide study shows that the MELD score and the serum sodium concentration are important predictors of survival among candidates for liver transplantation.

Subfields: Hepatology, Nutrition and Dietetics, Pulmonary and Respiratory Medicine

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Citations in the corpus

Diagnosis, Evaluation, and Management of Ascites, Spontaneous Bacterial Peritonitis and Hepatorenal Syndrome: 2021 Practice Guidance by the American Association for the Study of Liver Diseases (2021, background): “Many patients with RA also have hyponatremia, which is addressed by the model for end-stage liver disease-soduim (MELDNa) score (98-101).”
EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis. (2018, methodology): “Incorporating serum sodium concentration into MELD score, a new score (MELD-Na) was generated that provides more accurate survival prediction than MELD alone [149], especially in patients with ascites and hyponatremia with intermediate MELD score values [150].”
Evaluation for liver transplantation in adults: 2013 practice guideline by the American Association for the Study of Liver Diseases and the American Society of Transplantation (2014, background): “Development of hyponatremia in cirrhosis is a marker of increased waiting list mortality,(19) as well as neurological dysfunction post-LT.(20) Incorporation of serum sodium into the MELD score has been proposed to increase priority for organ allocation to candidates with hyponatremia to reduce waiti”
Clinical practice guideline on diagnosis and treatment of hyponatraemia. (2014, neutral): “Also in liver failure, hyponatraemia is associated with poorer survival [57].”
Development and validation of a prognostic score to predict mortality in patients with acute-on-chronic liver failure. (2014, background): “The CLIF-SOFAs, however, is complex (based on 6 subscores, each with a 5-point range, assessing liver, kidney, brain, coagulation, respiration, and circulation), is based on consensus and expert opinion rather than data, and does not significantly improve the prediction accuracy of the model for end”