Different methods of creatinine measurement significantly affect MELD scores

Cholongitas, Εvangelos; Marelli, Laura; Kerry, Andrew; Senzolo, Marco; Goodier, David; Nair, Devaki; Miles, Thomas J.; Patch, David; Burroughs, Andrew K.

doi:10.1002/lt.20994

Cited by 150 publications

(125 citation statements)

References 28 publications

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“…Further, in the presence of high serum bilirubin, the colorimetric method is unreliable and underestimates the value of creatinine; the enzymatic method is preferred for measuring the serum creatinine in such situations. 17 Another limitation is gender with lower value amongst females compared to men for the same level of renal function. 18 A study comparing glomerular filtration rate (GFR) based on Modification of Diet in Renal Disease (MDRD) formula and serum creatinine showed similar results in estimating waitlist mortality.…”

Section: Serum Creatininementioning

confidence: 99%

Model for End-stage Liver Disease

Singal

Kamath

2013

Journal of Clinical and Experimental Hepatology

125

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Section: Serum Creatininementioning

confidence: 99%

Model for End-stage Liver Disease

Singal

Kamath

2013

Journal of Clinical and Experimental Hepatology

125

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“…Possibly the most important study limitations were the relatively small sample size, the poor geographic diversity of the patients included (single and tertiary center) and the major drawbacks of the MELD score related to wide variability of laboratory parameters such as serum creatinine and bilirubin [28,41,42] .…”

Section: Discussionmentioning

confidence: 99%

Application of a biochemical and clinical model to predict individual survival in patients with end-stage liver disease

Vilar‐Gomez¹,

Bertot²,

Oramas³

et al. 2009

WJG

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AIM:To investigate the capability of a biochemical and clinical model, BioCliM, in predicting the survival of cirrhotic patients. METHODS:We prospectively evaluated the survival of 172 cirrhotic patients. The model was constructed using clinical (ascites, encephalopathy and variceal bleeding) and biochemical (serum creatinine and serum total bilirubin) variables that were selected from a Cox proportional hazards model. It was applied to estimate 12-, 52-and 104-wk survival. The model's calibration using the Hosmer-Lemeshow statistic was computed at 104 wk in a validation dataset. Finally, the model's validity was tested among an independent set of 85 patients who were stratified into 2 risk groups (low risk ≤ 8 and high risk > 8). RESULTS:In the validation cohort, all measures of fit, discrimination and calibration were improved when the biochemical and clinical model was used. The proposed model had better predictive values (c-statistic: 0.90, 0.91, 0.91) than the Model for End-stage Liver Disease (MELD) and Child-Pugh (CP) scores for 12-, 52-and 104-wk mortality, respectively. In addition, the HosmerLemeshow (H-L) statistic revealed that the biochemical and clinical model (H-L, 4.69) is better calibrated than MELD (H-L, 17.06) and CP (H-L, 14.23). There were no significant differences between the observed and expected survival curves in the stratified risk groups (low risk, P = 0.61; high risk, P = 0.77). CONCLUSION:Our data suggest that the proposed model is able to accurately predict survival in cirrhotic patients.

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“…For example, there are variations in assay methods used by different laboratories that can affect the value reported, 8 and for some clinical components (eg, cardiac risk), there may be no standardized approach or definition.…”

Section: Methods For Comparing Performancementioning

confidence: 99%

Review of methods for measuring and comparing center performance after organ transplantation

2010

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The assessment of outcomes after transplantation is important for several reasons: it provides patients with data so that they can make informed decisions about the benefits of transplantation and the success of the transplant unit; it informs commissioners that resources are allocated properly; and it provides clinicians reassurance that results are acceptable or, if they are not, provides early warning so that problems can be identified, corrections can be instituted early, and all interested parties can be reassured that scarce resources are used fairly. The need for greater transparency in reporting outcomes after liver transplantation and for comparisons both between and within centers has led to a number of approaches being adopted for monitoring center performance. We review some of the commonly used methods, highlight their strengths and weaknesses, and concentrate on methods that incorporate risk adjustment. Measuring and comparing outcomes after transplantation is complex, and there is no single approach that gives a complete picture. All those using analyses of outcomes must understand the merits and limitations of individual methods. When used properly, such methods are invaluable in ensuring that a scarce resource is used effectively, any adverse trend in outcomes is identified promptly and remedied, and best performers are identified; they thus allow the sharing of best practices. However, when they are used inappropriately, such measurements may lead to inappropriate conclusions, encourage risk-averse behavior, and discourage innovation.

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Different methods of creatinine measurement significantly affect MELD scores

Cited by 150 publications

References 28 publications

Model for End-stage Liver Disease

Model for End-stage Liver Disease

Application of a biochemical and clinical model to predict individual survival in patients with end-stage liver disease

Review of methods for measuring and comparing center performance after organ transplantation

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