This article is more than 5 years old. Information may no longer be current.

Child-Turcotte-Pugh scores, hyponatremia predicted mortality better than MELDNa scores

Elevated Child-Turcotte-Pugh scores and the presence of severe hyponatremia may be better predictors of mortality among patients with cirrhosis and refractory ascites than MELDNa scores, according to recent results.

In a consecutive, single-center, observational prospective study, researchers evaluated 174 patients with cirrhosis and refractory ascites in order to determine predictive mortality factors and establish the prognostic value of MELDNa scores within the cohort.

Low serum sodium levels (less than 130 mmol/L) were found in 66 participants (37.9%), and 61 cases of diuretic-intractable ascites were reported as a result of severe hyponatremia (less than 125 mmol/L). The cumulative mortality rate within 1 year was 55% (95% CI, 55-56%) and 67% within 2 years (95% CI, 67-68%), with causes including sepsis (51 patients), spontaneous bacterial peritonitis (12 patients) and hepatocellular carcinoma (26 patients).

Patients had a median MELDNa score of 23 (10-33). Among participants with a MELDNa score less than 23, 36 died (45.6%) compared with 78 patients (82.1%) with a score of 23 or greater (P<.0001). After 1 year, the cumulative mortality rate was 33% (95% CI, 33-34%) in patients with a score less than 23 and 73% (95% CI, 72-73%) in patients with a score of 23 or greater (P<001).

Following multivariate analysis, predictive factors of mortality across the cohort included Child-Turcotte-Pugh (CTP) scores (adjusted HR=1.43, 95% CI, 1.28-1.60), severe hyponatremia due to ascites (adjusted HR=2.11, 95% CI, 1.34-3.34), beta-blocker usage (adjusted HR=2.04, 95% CI, 1.31-3.18) and a high frequency of large-volume paracentesis (adjusted HR=1.42, 95% CI, 1.25-1.61). The area under the receiver operating characteristic curve in predicting mortality risk was highest for CTP scores (0.89, 95% CI, 0.85-0.94), compared with MELDNa scores (0.72, 95% CI, 0.63-0.80) and MELD scores (0.58, 95% CI, 0.49-0.67), and the difference between the values for CTP and MELDNa was considered statistically significant (P<.0001).

“The present prospective study is the first to demonstrate that severe hyponatremia as an underlying cause of refractory ascites and CTP score are better predictors of mortality than MELDNa in a well-defined population of patients with refractory ascites,” the researchers wrote.