C-reactive protein and model for end-stage liver disease score: Have we found the fifth element?

Abstract

The natural history of cirrhosis varies from patient to patient, depends on a number of factors, and is largely unpredictable. The transition from the compensated phase to the decompensated phase is dictated on one hand by the loss of liver cell mass and on the other hand by the development of complications of portal hypertension. Many studies have confirmed that the Model for End-Stage Liver Disease (MELD) is highly accurate for assessing the degree of hepatic insufficiency and short-term prognosis (90 days) in patients with cirrhosis in both transplant and nontransplant settings. However, approximately 15% to 20% of candidates for liver transplantation are not well served by MELD. A few years ago, our group showed that the addition of serum sodium to the MELD formula significantly increased its efficacy. The replacement of MELD by MELD-Na will allow earlier access to liver transplantation, especially for patients with severe portal hypertension and ascites but with relatively well-preserved liver function and normal serum creatinine