Model for end-stage liver disease score to serum sodium ratio index as a prognostic predictor and its correlation with portal pressure in patients with liver cirrhosis

Background: The models for end-stage liver disease (MELD) and serum sodium (SNa) are important prognostic markers in cirrhosis. A novel index, MELD to SNa ratio (MESO), was developed to amplify the opposing effect of MELD and SNa on outcome prediction. Methods: A total of 213 cirrhotic patients undergoing hepatic venous pressure gradient (HVPG) measurement were retrospectively analyzed. Results: The MESO index correlated with HVPG (r = 0.258, P < . 001) and Child-Pugh score (r = 0.749, P < 0.001). Using mortality as the end point, the area under receiver operating characteristic curve (AUC) was 0.860 for SNa, 0.795 for the MESO index and 0.789 for MELD (P values all 40.3) at 3 months. Among patients with Child-Pugh class A or B, the MESO index had a significantly higher AUC compared with MELD (0.80 vs. 0.766, P < 0.001). A MESO index < 1.6 identified 97% of patients who survived at 3 months and the predicted survival rate was 96.5%. In survival analysis, MESO index 41.6 independently predicted a higher mortality rate (relative risk: 3.32, P < 0001) using the Cox model. Conclusions: The MESO index, which takes into account the predictive power of both MELD and SNa, is a useful prognostic predictor for both short- and long-term survival in cirrhotic patients.