Interlaboratory variability in assessment of the model of end‐stage liver disease score

Lisman, Ton; Leeuwen, Yvonne van; Adelmeijer, Jelle; Pereboom, Ilona T. A.; Haagsma, Elizabeth B.; Berg, A. P. van den; Porte, Robert J.

doi:10.1111/j.1478-3231.2008.01783.x

Cited by 74 publications

(48 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Inter-laboratory INR variability in patients with liver disease leads to a median MELD score difference between the highest and lowest scoring laboratories of three to five points, with individual differences reaching up to eleven or twelve points [88][89][90]. The impact of such variability on the organ allocation system is self-evident.…”

Section: Intrinsic Weaknesses Of the Meld Score: The Shortcomings Of mentioning

confidence: 96%

The MELD score in patients awaiting liver transplant: Strengths and weaknesses

Bernardi

Gitto

Biselli

2011

Journal of Hepatology

146

127

View full text Add to dashboard Cite

Adoption of the Model for End-stage Liver Disease (MELD) to select and prioritize patients for liver transplantation represented a turning point in organ allocation. Prioritization of transplant recipients switched from time accrued on the waiting list to the principle of "sickest first". The MELD score incorporates three simple laboratory parameters (serum creatinine and bilirubin, and INR for prothrombin time) and stratifies patients according to their disease severity in an objective and continuous ranking scale. Concordance statistics have demonstrated its high accuracy in stratifying patients according to their risk of dying in the short-term (three months). Further validations of MELD as a predictor of survival at various temporal end-points have been obtained in independent patient cohorts with a broad spectrum of chronic liver disease. The MELD-based liver graft allocation policy has led to a reduction in waitlist new registrations and mortality, shorter waiting times, and an increase in transplants, without altering overall graft and patient survival rates after transplantation. MELD limitations are related either to the inter-laboratory variability of the parameters included in the score, or to the inability of the formula to predict mortality accurately in specific settings. For some conditions, such as hepatocellular carcinoma, widely accepted MELD corrections have been devised. For others, such as persistent ascites and hyponatremia, attempts to improve MELD's predicting power are currently underway, but await definite validation.

show abstract

Section: Intrinsic Weaknesses Of the Meld Score: The Shortcomings Of mentioning

confidence: 96%

The MELD score in patients awaiting liver transplant: Strengths and weaknesses

Bernardi

Gitto

Biselli

2011

Journal of Hepatology

146

127

View full text Add to dashboard Cite

show abstract

“…Consequently, the MELD Score (in which serum creatinine is one of the contributing parameters) is nowadays widely used to prioritize patients for liver transplantation: MELD Scoresw0.957=ln(serum creatinine; mg/dL)q0.378= ln(serum bilirubin; mg/dL)q1.120=ln(International Normalized Ratio)q0.643)=10 (if hemodialysis, value for creatinine is automatically set to 4.0 mg/dL). Substantial and clinically relevant interlaboratory variation in the MELD Score has been reported (43). The mean difference in the MELD Score between the highest-and the lowest-scoring laboratory was 4.8.…”

Section: Transplantation Medicinementioning

confidence: 96%

Focusing on the clinical impact of standardization of creatinine measurements: a report by the EFCC Working Group on Creatinine Standardization

Delanghe

Cobbaert

Harmoinen

et al. 2011

Clinical Chemistry and Laboratory Medicine

View full text Add to dashboard Cite

The recent campaign for standardization of creatinine measurements has been promoted to allow the widespread use of formulas for estimating the glomerular filtration rate (GFR). However, studies on trueness verification and measurement interferences still show disappointing interassay variation of serum creatinine results. Creatinine recalibration has major clinical consequences. In particular, in pediatrics where reference ranges for serum and plasma creatinine are low, calculation of the GFR is problematic when based on alkaline picrate methods because of method non-specificity and the lack of appropriate GFR estimating formulas. Therefore, enzymatic creatinine assays are preferred. In the near future, cystatin C might offer an interesting alternative for GFR estimation. For the calculation of drug doses, the Modification of Diet in Renal Disease study formula generally offers reliable data. However, attention has to be paid to the elderly. Also, the calculation of the Model for End-Stage Liver Disease score, which is used to prioritize patients for liver transplantation, may significantly be influenced by recalibration of creatinine assays. Creatinine restandardization may also affect the current guidelines for referral of chronic kidney disease patients to nephrologists.

show abstract

“…Also, the administration of vitamin K antagonists is difficult, since the INR of the PT is frequently prolonged in patients with cirrhosis, and it is thus unclear which target INR is safe. Furthermore, INR determinations in patients with liver disease suffer from unacceptably high interlaboratory variation [119,120]. The new direct factor Xa and thrombin inhibitors have theoretical advantages over heparin and vitamin K antagonists, but for these agents suitable antidotes are still lacking.…”

Section: Venous Thrombosismentioning

confidence: 99%