Value of MELD score, MELD-Na score, and King's College Hospital criteria in evaluating the prognosis of patients with acute liver failure of pregnancy

Objective To investigate the value of the Model for End-Stage Liver Disease ( MELD) score, MELD combined with serum sodium concentration ( MELD-Na) score, and King's College Hospital ( KCH) criteria in evaluating the prognosis of patients with acute liver failure ( ALF) of pregnancy. Methods A total of 50 patients who were admitted to the Third Affiliated Hospital of Guangzhou Medical University from January 1, 2010 to June 30, 2017 with ALF of pregnancy as the initial diagnosis were enrolled, and according to prognosis, they were divided into death group and survival group. The patients were evaluated using the MELD score, MELD-Na score, and KCH criteria, and the association between these models and prognosis was analyzed. The t-test or Mann-Whitney U test was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data between groups. The receiver operating characteristic ( ROC) curve was plotted; the sensitivity, specificity, positive predictive value, and negative predictive value of each model were calculated; the area under the ROC curve ( AUC) was used to analyze the value of these three models in predicting the prognosis of patients with ALF of pregnancy. Results Of all 50 patients, 14 died and 36 survived, resulting in a mortality rate of 28. 0%. Compared with the survival group on admission, the death group had significant increases in MELD score ( 39. 66 ± 5. 17 vs 29. 63 ± 6. 19, t = 5. 36, P <0. 05) and MELD-Na score ( 43. 89 ± 9. 85 vs 31. 32 ± 7. 29, t = 4. 94, P < 0. 05) . On day 3 after admission, the death group had significantly higher MELD score and MELD-Na score than the survival group ( MELD score: 44. 24 ± 3. 96 vs 28. 74 ± 3. 84, t =-12. 68, P <0. 05; MELD-Na score: 46. 34 ± 5. 14 vs 32. 42 ± 4. 95, t =-8. 82, P < 0. 05) . There was no significant difference in mortality rate between the patients who met the KCH criteria and those who did not ( 8/25 vs 6/25, χ2= 0. 397, P = 0. 754) . The ROC curve analysis showed that baseline MELD score had an AUC of 0. 885 ( 95% confidence interval [CI]: 0. 781-0. 988, P < 0. 01) , a sensitivity of71. 4%, and a specificity of 94. 4%; MELD-Na score had an AUC of 0. 873 ( 95% CI: 0. 764-0. 982, P < 0. 01) , a sensitivity of78. 6%, and a specificity of 88. 9%; KCH criteria had an AUC of 0. 548 ( 95% CI: 0. 392-0. 670, P < 0. 05) , a sensitivity of 57. 1%, and a specificity of 52. 7%. Baseline MELD score and MELD-Na score were divided into groups according to the cut-off value of ROC curve, and the analysis showed that the mortality rate of patients increased with the increases in MELD score and MELD-Na score ( χ2=21. 337 and 17. 294, both P < 0. 001) . Conclusion MELD score, MELD-Na score, and KCH criteria can predict the prognosis of patients with ALF of pregnancy, and MELD score and MELD-Na score have a better clinical value than the KCH criteria.