The Model for End-Stage Liver Disease (MELD) score is an important and well established tool for assessing prognosis in patients with liver cirrhosis. It has been suggested that the longitudinal evaluation of the MELD score may reflect the progression of liver failure more reliably and therefore be more useful in prognostic assessment.
To assess the prognostic meaning of MELD score modifications in a cohort of cirrhotic patients in whom clinical and biochemical workup was carried out at least twice during a minimum interval of 30 days.
Forty-six cirrhotic patients were longitudinally evaluated for a median follow-up of 365 days. After initial assessment, all the patients had at least one clinical and biochemical reevaluation during follow-up, which was performed no less than 1 month after initial evaluation. MELD was calculated at entry and at second evaluation. ΔMELD was calculated as MELD at second evaluation minus MELD at entry. ΔMELD/time was calculated as ΔMELD divided by time elapsed between initial assessment and second evaluation expressed in months.
During follow-up, 13 patients died (28%). The median interval between clinical evaluations was 120 days. MELD scores at entry (13 ± 4 vs 16 ± 6, P = 0.0516) and ΔMELD (0 ± 4 vs 4 ± 2, P = 0.0028) were significantly different between patients who died and those who survived during the 1-year follow-up. All the patients who died during follow-up showed an increase of at least 1 unit in ΔMELD/time (sensitivity = 100%), and all the patients who survived showed a decrease of more than 1 unit in ΔMELD/time (specificity = 100%).
Longitudinal evaluation of the MELD score provides important prognostic information that seems to complete the prognostic definition provided by “static” MELD. Prospective studies in larger series are needed to validate the prognostic use of MELD modifications over time.
From the *Gastroenterology Unit, Department of Internal Medicine, and †Biostatistics Unit, Department of Health Sciences, University of Genoa, Genoa, Italy.
Received for publication February 2, 2005; accepted April 26, 2005.
Presented in part at the 11th Annual Meeting of the Federazione Nazionale delle Malattie Digestive, March 12-15, 2005, Genoa, Italy.
Reprints: Edoardo G. Giannini, MD, PhD, Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Viale Benedetto XV, no. 6, 16132, Genoa, Italy (e-mail: firstname.lastname@example.org).