The Model for End-stage Liver Disease accurately predicts 90-day liver transplant wait-list mortality in Atlantic Canada.

Abstract

OBJECTIVE:

To determine the generalizability of the predictions for 90-day mortality generated by Model for End-stage Liver Disease (MELD) and the serum sodium augmented MELD (MELDNa) to Atlantic Canadian adults with end-stage liver disease awaiting liver transplantation (LT).

METHODS:

The predictive accuracy of the MELD and the MELDNa was evaluated by measurement of the discrimination and calibration of the respective models' estimates for the occurrence of 90-day mortality in a consecutive cohort of LT candidates accrued over a five-year period. Accuracy of discrimination was measured by the area under the ROC curves. Calibration accuracy was evaluated by comparing the observed and model-estimated incidences of 90-day wait-list failure for the total cohort and within quantiles of risk.

RESULTS:

The area under the ROC curve for the MELD was 0.887 (95% CI 0.705 to 0.978) - consistent with very good accuracy of discrimination. The area under the ROC curve for the MELDNa was 0.848 (95% CI 0.681 to 0.965). The observed incidence of 90-day wait-list mortality in the validation cohort was 7.9%, which was not significantly different from the MELD estimate of 6.6% (95% CI 4.9% to 8.4%; P=0.177) or the MELDNa estimate of 5.8% (95% CI 3.5% to 8.0%; P=0.065). Global goodness-of-fit testing found no evidence of significant lack of fit for either model (Hosmer-Lemeshow c2 [df=3] for MELD 2.941, P=0.401; for MELDNa 2.895, P=0.414).

CONCLUSION:

Both the MELD and the MELDNa accurately predicted the occurrence of 90-day wait-list mortality in the study cohort and, therefore, are generalizable to Atlantic Canadians with end-stage liver disease awaiting LT.

• Authors: Paul Douglas Renfrew, Hude Quan, Christopher James Doig, Elijah Dixon, Michele Molinari
• Journal: Canadian journal of gastroenterology = Journal canadien de gastroenterologie (Can J Gastroenterol) Vol. 25 Issue 7 Pg. 359-64 (Jul 2011) ISSN: 0835-7900 [Print] Canada
• PMID: 21876856 (Publication Type: Journal Article)

Topics

• Adult
• Aged
• End Stage Liver Disease (mortality, surgery)
• Female
• Humans
• Liver Transplantation
• Male
• Middle Aged
• Nova Scotia (epidemiology)
• Prognosis
• ROC Curve
• Severity of Illness Index
• Waiting Lists (mortality)