Different serum sodium assay, different model for end stage liver disease - sodium scores in patients awaiting liver transplant: A cross-sectional study

Abstract

Introduction and aims: Sodium can be measured with direct or indirect methods, abnormal plasma total protein concentration can impact on sodium measured by indirect ion-selective electrodes (ISE). Serum sodium is an important item to determine the Model for End Stage Liver Disease Sodium (MELD-Na) score, commonly used for liver graft allocation. Patients with cirrhosis usually have hypoproteinemia. The aim of this study was to determine if there was a significant difference between the MELD-Na scores calculated based on the results of two different serum sodium ISE: indirect and direct. 
 Methods: This was a retrospective study, we included 166 patients that underwent liver transplant assessment, and that had paired (i.e. same date and time) direct and indirect sodium determinations. We calculated the MELD-Na scores with both sodium determinations, and we compared them. 
 Results: There was a significant difference between MELD-Na scores, the mean difference was 0.4+1.3. If MELD-Na score had been determined by the sodium measured by the direct ISE, 69 patients (42%) would have stayed in the same place on the waiting list, 67 patients (40%) would have moved up, and 30 patients (18%) would have moved down. 
 Conclusions: There was a statistically significant difference between the MELD-Na scores calculated based on the two different sodium concentrations, which would theoretically result in changes in the order of the waiting list. This finding should prompt studies to assess if MELD-Na calculated based on direct methods has a better performance to predict clinically relevant outcomes.

EHMT2 Inactivation in Pancreatic Epithelial Cells Shapes the Transcriptional Landscape and Inflammation Response of the Whole Pancreas

“…The decrease in circulating albumin, coupled with heightened inflammation in Ehmt2 fl/fl mice, suggests a potential increase in capillary permeability and the efflux of circulating albumin into interstitial spaces (Soeters, Wolfe, and Shenkin 2019), which is seen in cases of acute pancreatitis (Xu et al 2023). The reduction in albumin, along with diminished total protein levels in Ehmt2 fl/fl serum implies a potential impairment in liver function (Soeters, Wolfe, and Shenkin 2019; Pompili et al 2023; Wen et al 2022; Rodriguez-Alvarez et al 2023). Furthermore, decreased ALP levels in Ehmt2 fl/fl serum may directly result from compromised liver function (Iluz-Freundlich et al 2021).…”