Clinical

Serum sodium helps prioritize liver transplant candidates

Last Updated: 2005-03-04 13:41:02 -0400 (Reuters Health)

By David Douglas

NEW YORK (Reuters Health) - Investigation of serum sodium levels is a useful addition to the MELD (model for end-stage liver disease) score in gauging mortality risk in patients waiting for liver transplantation, US and Argentinean researchers report in the March issue of Liver Transplantation.

Lead investigator Dr. Andres E. Ruf told Reuters Health that the MELD score "has worked well to stratify liver transplant candidates on the US waiting list according to the severity of liver failure and thus to prioritize allocation of organ donors to those in more urgent need."

However, "it has been recognized that a number of patients with poor prognosis have a rather low MELD score and therefore are not well served by this system."

Therefore Dr. Ruf, of Fundacion Favaloro in Buenos Aires, and colleagues investigated the prognostic value of serum sodium in 262 cirrhotic patients.

During 3 months of follow-up 19 (7%) died, 175 (67%) survived and 68 (26%) underwent liver transplantation.

Hyponatremia (sodium serum below 130 mEq/L) was seen in 63% of patients who died compared with 13% of those who survived. Hyponatremia and serum sodium were significant predictors of mortality.

Moreover, the risk of death across all MELD scores was higher for patients with hyponatremia than those without. Each increase of 1 mEq/L of serum sodium was associated with a decreased odds ratio of 0.95.

Serum sodium added to the MELD, Dr. Ruf concluded, "increases significantly the accuracy of the score to predict waitlist mortality."

Liver Transpl 2005;11:336-343