Evidence-Based Medicine
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Aug 18, 2015; 7(17): 2119-2126
Published online Aug 18, 2015. doi: 10.4254/wjh.v7.i17.2119
Model for end-stage liver disease-Na score or Maddrey discrimination function index, which score is best?
Mercedes Amieva-Balmori, Scherezada María Isabel Mejia-Loza, Roberto Ramos-González, Felipe Zamarripa-Dorsey, Eli García-Ruiz, Nuria Pérez y López, Eumir I Juárez-Valdés, Adriana López-Luria, José María Remes-Troche
Mercedes Amieva-Balmori, Scherezada María Isabel Mejia-Loza, Roberto Ramos-González, Felipe Zamarripa-Dorsey, Eli García-Ruiz, Nuria Pérez y López, Eumir I Juárez-Valdés, Adriana López-Luria, Servicio de Gastroenterología, Instituto de Investigaciones Médico-Biológicas de la Universidad Veracruzana, Hospital Juárez de México, Ciudad de México 07760, México
José María Remes-Troche, Laboratorio de Fisiología Digestiva, Instituto de Investigaciones Médico-Biológicas de la Universidad Veracruzana, De La Veracruz 51356, México
Author contributions: Amieva-Balmori M and Remes-Troche JM contributed to the outlining of the study, generation, collection, assembly, analysis and/or interpretation of data and writing and revision of the manuscript; Mejia-Loza SMI, Ramos-González R, López-Luria A, García-Ruiz E, Pérez y López N, and Juárez-Valdés EI contributed to the generation, collection, analysis and assembly of data; Zamarripa-Dorsey F contributed to the analysis and/or interpretation of data and writing and revision of the manuscript; all authors approved the final version of the manuscript.
Conflict-of-interest statement: Amieva-Balmori M, Mejia-Loza SMI, Ramos-González R, López-Luria A, García-Ruiz E, Pérez y López N, Juárez-Valdés EI and Zamarripa-Dorsey F do not have conflict of interest. José María Remes-Troche is member of the Advisory Board for Takeda Pharmaceuticals, Alfa-Wasserman, Almirall and Janssen. Also, he is Speaker for Nycomed-Takeda, Advance Medical, Endomedica, Astra-Zeneca and Bristol-Myers-Squibb.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Mercedes Amieva-Balmori, MD, Servicio de Gastroenterología, Instituto de Investigaciones Médico-Biológicas de la Universidad Veracruzana, Hospital Juárez de México, Av. Instituto Politécnico Nacional 5160, Gustavo A. Madero, Magdalena de Las Salinas, Ciudad de México 07760, México. mercedesamieva@hotmail.com
Telephone: +52-55-57477560 Fax: +52-229-2021231
Received: October 10, 2014
Peer-review started: October 13, 2014
First decision: December 17, 2014
Revised: June 24, 2015
Accepted: July 16, 2015
Article in press: July 17, 2015
Published online: August 18, 2015
Abstract

AIM: To compare the ability of model for end-stage liver disease (MELD)-Na and Maddrey discrimination function index (DFI) to predict mortality at 30 and 90 d in patients with alcoholic hepatitis (AH).

METHODS: We prospectively assessed 52 patients with AH. Demographic, clinical and laboratory parameters were obtained. MELD-Na and Maddrey DFI were calculated on admission. Short-term mortality was assessed at 30 and 90 d. Receiver operating characteristic curve analysis was performed.

RESULTS: Thirty-day and 90-d mortality was 44% and 58%, respectively. In the univariate analysis, sodium levels was associated with mortality at 30 and 90 d (P = 0.001 and P = 0.03). Child stage, encephalopathy, ascites, or types of treatment were not associated with mortality. MELD-Na was the only predictive factor for mortality at 90 d. For 30-d mortality area under the curve (AUC) was 0.763 (95%CI: 0.63-0.89) for Maddrey DFI and 0.784 for MELD-Na (95%CI: 0.65-0.91, P = 0.82). For 90-d mortality AUC was 0.685 (95%CI: 0.54-0.83) for Maddrey DFI and 0.8710 for MELD-Na (95%CI: 0.76-0.97, P = 0.041).

CONCLUSION: AH is associated with high short-term mortality. Our results show that MELD-Na is a more valuable model than DFI to predict short-term mortality.

Keywords: Alcoholic hepatitis, Model for end-stage liver disease-Na, Maddrey, Mortality

Core tip: Alcoholic hepatitis (AH) is a severe condition associated with high mortality. The model for end-stage disease (MELD) score is widely used to predict mortality in end-stage liver disease, and the addition of sodium (MELD-Na) increase its utility. However, few studies have evaluated the utility of MELD-Na in AH. In this study, we found that MELD-Na is useful for predicting 90-d mortality in patients with AH and preserve prognostic advantage over Maddrey discrimination function index score. It represents a valuable tool to stratify patients by risk, however further studies are required to validate the prognostic utility of MELD-Na score in patients with AH.