Q: Why sodium has been made part of MELD-Na score?
Answer: In January 2016 MELD (Model For End-Stage Liver Disease) score was updated to include serum sodium after evidences showed that severity of the hyponatremia corelates with the severity of cirrhosis and vasodilatory state. There is a linear increase in mortality by 5 percent for each mmol decrease in serum sodium between 125 and 140 mmol/L.
Said that clinicians should be reminded that serum sodium can be manipulated by volume status and diuretic use.
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References:
1. Kim WR, Biggins SW, Kremers WK, et al. Hyponatremia and mortality among patients on the liver-transplant waiting list. N Engl J Med 2008; 359:1018.
2. Londoño MC, Cárdenas A, Guevara M, et al. MELD score and serum sodium in the prediction of survival of patients with cirrhosis awaiting liver transplantation. Gut 2007; 56:1283.
3. Ruf AE, Kremers WK, Chavez LL, et al. Addition of serum sodium into the MELD score predicts waiting list mortality better than MELD alone. Liver Transpl 2005; 11:336.
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