Open Access Research article

Serum sodium based modification of the MELD does not improve prediction of outcome in acute liver failure

Paul Manka1, Lars P Bechmann1, Frank Tacke2, Jan-Peter Sowa1, Martin Schlattjan1, Julia Kälsch1, Christoph Jochum1, Andreas Paul3, Fuat H Saner3, Christian Trautwein2, Guido Gerken1 and Ali Canbay1*

Author Affiliations

1 Department of Gastroenterology and Hepatology, University Hospital, University Duisburg-Essen, Hufelandstr 55, Essen, 45122, Germany

2 Department of Medicine III (Gastroenterology and Metabolic Disorders), University Hospital Aachen, Aachen, Germany

3 Department of General, Visceral and Transplantation Surgery, University Hospital, University Duisburg-Essen, Essen, Germany

For all author emails, please log on.

BMC Gastroenterology 2013, 13:58  doi:10.1186/1471-230X-13-58

Published: 3 April 2013



Acute liver failure (ALF) is a devastating clinical syndrome with a high mortality rate. The MELD score has been implied as a prognostic tool in ALF. Hyponatremia is associated with lethal outcome in ALF. Inclusion of serum sodium (Na) into the MELD score was found to improve its predictive value in cirrhotic patients. Therefore the aim of this study was to determine whether inclusion of serum Na improves the predictive value of MELD in ALF compared to established criteria.


In a prospective single center study (11/2006–12/2010), we recruited 108 consecutive ALF patients (64% females / 36% males), who met the criteria defined by the “Acute Liver Failure Study Group Germany”. Upon admission, clinical and laboratory data were collected, King’s College Criteria (KCC), Model of End Stage Liver Disease score (MELD), and serum sodium based modifications like the MELD-Na score and the United Kingdom Model of End Stage Liver Disease score (UKELD) were calculated and area under the receiver operating characteristic curve analyses were performed regarding the prediction of spontaneous recovery (SR) or non-spontaneous recovery (NSR; death or transplantation).


Serum bilirubin was of no prognostic value in ALF, and Na also failed to predict NSR in ALF. The classical MELD score was superior to sodium-based modifications and KCC.


We validated the prognostic value of MELD-Na and UKELD in ALF. Classic MELD score calculations performed superior to KCC in the prediction of NSR. Serum Na and Na-based modifications of MELD did not further improve its prognostic value.