Influential factors in predicting the prognosis of patients with chronic severe hepatitis using MELD scoring system

Objective To predict prognosis in patients with chronic severe hepatitis (CSH) by model for end-stage liver disease (MELD) scoring system and study the effects of age, sex, etiology, low serum sodium, persistent ascites on MELD. Methods MELD scores of 300 patients with CSH were calculated according to the original formula. The 3-month's mortality was measured, and the validity of the model was determined by means of the concordance(c) statistic. The influential factors of MELD were also studied.Results In the groups with MELD score 20～29, 30～39 and over 40, the 3-month's mortality of patients with CSH was 56.0% , 76.5% , 98.2% respectively. The c statistic of 3-month's mortality was 0.782 . Univariate analysis showed that mortality was significantly related to age (P= 0.047 ), etiology (P= 0.039 ), serum sodium (P= 0.029 ) and ascites (P= 0.031 ) for patients with MELD scores 20～29. In multivariate analysis, in patients with MELD scores 20～29, age (P= 0.012 ), etiology (P= 0.024 ), serum sodium (P= 0.005 ) and ascites (P= 0.017 ) were independent predictors of mortality; for MELD scores over 30, only MELD scores (P= 0.015 ) was independent predictive. Conclusion MELD is a reliable method for predicting the mortality in patients with CSH. In the group of MELD score 20～29, the factors including age, etiology, presence of low serum sodium and persistent ascites may influence MELD scoring system. The MELD score is the decisive predictor of prognosis of patients with CSH when MELD scores is over 30.