Model for End-Stage Liver Disease and Sodium Velocity Predicts Overall Survival in Nonmetastatic Hepatocellular Carcinoma Patients

الملخص EN

Background & Aims.

The significance of short-term changes in model for end-stage liver disease and Sodium (MELD-Na) following hepatocellular carcinoma (HCC) diagnosis is unknown.

In this report, we explore the value of the rate of short-term changes in MELD-Na as an independent predictor of mortality in patients with nonmetastatic HCC.

Methods.

We reviewed a cohort of patients diagnosed with nonmetastatic HCC at our institution between 2001 and 2011.

We evaluated potential predictors of overall survival, including baseline MELD-Na and the change in MELD-Na over 90 days.

We explored survival times of cohorts grouped by baseline MELD-Na and the change in MELD-Na.

Results.

182 patients met eligibility criteria.

With a median follow-up of 21 months for surviving patients, 110 deaths were observed (60%).

Median MELD-Na at the time of diagnosis was 9.7 (IQR 7.5 to 13.9).

The median changes in percentage of MELD-Na over 90 days were an increase of 9% (IQR -4% to 55%).

Multivariable Cox proportional hazards modeling demonstrated that both baseline MELD-Na (HR=1.07 per unit increase, 95% CI 1.03 to 1.11, p<0.001) and changes in MELD-Na exceeding 40% (HR=3.69, 95% CI 2.39 to 5.69, p<0.001) were independently associated with increased mortality risk.

Median survival among patients whose changes in MELD-Na were greater than 40% was 4.5 months, and median survival among the 131 other patients was 25.8 months (p<0.001).

Conclusions.

We identified a subset of HCC patients who have extremely poor prognosis by incorporating the rate of short-term change in MELD-Na to baseline MELD-Na score.