Is an estimated glomerular filtration rate better than creatinine to be incorporated into the end-stage liver disease score?

Table 1 Clinical characteristics, demographic data and laboratory data of 3857 cirrhotic patients

Parameter	All patients (n = 3857)	Survivors (n = 2375)	Non-survivors (n = 1482)	P value
Age, yr	60.73 ± 14.05	59.02 ± 14.02	63.48 ± 13.65	< 0.001
Male, n (%)	2665 (69.1)	1651 (69.52)	1014 (68.42)	NS (0.474)
Hepatoma, n (%)	1385 (35.9)	653 (27.5)	732 (49.4)	< 0.001
Cause of liver cirrhosis, n (%)				< 0.001
Hepatitis C	930 (24.1)	568 (23.9)	362 (24.4)	-
Hepatitis B	1090 (28.3)	631 (26.6)	459 (31)	-
Alcoholic	813 (21.1)	580 (24.4)	233 (15.7)	-
Hepatitis C + hepatitis B	106 (2.7)	70 (2.9)	36 (2.4)	-
Hepatitis C + alcohol	60 (1.6)	39 (1.6)	21 (1.4)	-
Hepatitis B + alcohol	191 (5)	127 (5.3)	64 (4.3)	-
Hepatitis C + hepatitis B + alcohol	33 (0.9)	19 (0.8)	14 (0.9)	-
Not hepatitis C, hepatitis B or alcohol	634 (16.4)	341 (14.4)	293 (19.8)	-
Ascites, n (%)	1861 (48.2)	825 (34.7)	1036 (69.9)	< 0.001
Hepatic encephalopathy, n (%)	1097 (28.4)	434 (18.3)	663 (44.7)	< 0.001
Child–Pugh points	8.36 ± 2.57	7.11 ± 1.97	10.37 ± 2.1	< 0.001
MELD score	18.9 ± 10.26	13.15 ± 5.57	27.98 ± 9.36	< 0.001
Albumin, 3.5-5 g/dL	2.95 ± 0.73	3.24 ± 0.68	2.49 ± 0.55	< 0.001
Total bilirubin, 0.3-1.2 mg/dL	5.18 ± 8.16	2.24 ± 3.57	9.89 ± 10.81	< 0.001
INR	1.89 ± 1.75	1.43 ± 0.43	2.72 ± 2.55	< 0.001
BUN, 8-12 mg/dL	34.47 ± 35.55	17.63 ± 15.52	61.44 ± 41.49	< 0.001
Creatinine, 0.4-1.2 mg/dL	1.94 ± 1.91	1.27 ± 1.35	3.01 ± 2.17	< 0.001
eGFR, mL/(min∙1.73 m-2) (MDRD-4)	63.17 ± 46.12	79.14 ± 37.4	37.57 ± 47.24	< 0.001
eGFR, mL/(min∙1.73 m-2) (MDRD-6)	54.87 ± 38.25	70.85 ± 33.29	29.32 ± 31.16	< 0.001
eGFR, mL/(min∙1.73 m-2) (CKD-EPI)	65.39 ± 37.49	82.11 ± 30.28	38.59 ± 31.99	< 0.001

Values were expressed as mean ± SD unless otherwise defined. Statistical comparison was performed with Student’s t and χ² test. MELD: Model for end-stage liver disease; INR: International normalized ratio; BUN: Blood urea nitrogen; eGFR: Estimated glomerular filtration rate; MDRD: Modification of diet in renal disease; MDRD-4: 4-variable MDRD; MDRD-6: 6-variable MDRD; CKD-EPI: The chronic kidney disease epidemiology collaboration; NS: Not significant.

Table 2 Univariate and multivariate logistic regression analyses of the various parameters in predicting in-hospital mortality

Parameter	Beta coefficient	Standard error	Odds ratios (95% CI)	P value
Univariate logistic regression analysis
Age, yr	0.02	0.00	1.02 (1.02-1.03)	< 0.001
Hepatoma	0.95	0.07	2.57 (2.25-2.95)	< 0.001
Ascites	1.47	0.07	4.36 (3.80-5.02)	< 0.001
Hepatic encephalopathy	1.29	0.07	3.62 (3.13-4.19)	< 0.001
Cause of liver cirrhosis (reference group: NBNCNA)
Hepatitis C	-0.30	0.10	0.74 (0.61-0.91)	0.004
Hepatitis B	-0.17	0.10	0.85 (0.70-1.03)	NS (0.098)
Alcoholic	-0.76	0.11	0.47 (0.38-0.58)	< 0.001
Hepatitis C + hepatitis B	-0.51	0.22	0.60 (0.39-0.92)	0.020
Hepatitis C + alcoholic	-0.53	0.17	0.59 (0.42-0.82)	0.002
Hepatitis B + alcoholic	-0.15	0.36	0.86 (0.42-1.74)	NS (0.670)
Hepatitis C + hepatitis B + alcoholic	-0.47	0.28	0.63 (0.36-1.09)	NS (0.098)
Child–Pugh points	0.67	0.02	1.95 (1.87-2.03)	< 0.001
MELD score	0.22	0.01	1.25 (1.23-1.27)	< 0.001
BUN, mg/dL	0.07	0.00	1.07 (1.06-1.07)	< 0.001
Creatinine, mg/dL	0.72	0.03	2.05 (1.93-2.18)	< 0.001
eGFR, mL/(min∙1.73 m-2) (MDRD-4)	-0.04	0.00	0.97 (0.96-0.97)	< 0.001
eGFR, mL/(min∙1.73 m-2) (MDRD-6)	-0.05	0.00	0.95 (0.95-0.96)	< 0.001
eGFR, mL/(min∙1.73 m-2) (CKD-EPI)	-0.04	0.00	0.97 (0.96-0.96)	< 0.001
Albumin, g/dL	-1.97	0.07	0.14 (0.12-0.16)	< 0.001
Total bilirubin, mg/dL	0.20	0.01	1.22 (1.20-1.25)	< 0.001
INR	1.74	0.08	5.70 (4.87-6.67)	< 0.001
Multivariate logistic regression analysis
Age, yr	0.03	0.01	1.03 (1.01-1.04)	< 0.001
Hepatoma	0.95	0.13	2.60 (2.02-3.34)	< 0.001
Cause of liver cirrhosis (reference group: NBNCNA)
Hepatitis C	-0.19	0.18	0.83 (0.58-1.18)	NS (0.299)
Hepatitis B	-0.28	0.19	0.76 (0.52-1.10)	NS (0.139)
Alcoholic	-0.21	0.22	0.81 (0.52-1.25)	NS (0.342)
Hepatitis C + hepatitis B	-1.03	0.40	0.36 (0.16-0.78)	0.010
Hepatitis C + alcoholic	-0.79	0.35	0.46 (0.23-0.90)	0.023
Hepatitis B + alcoholic	0.32	0.57	1.38 (0.45-4.22)	NS (0.576)
Hepatitis C + hepatitis B + alcoholic	0.54	0.47	1.71 (0.68-4.29)	NS (0.354)
MELD score	0.14	0.03	1.14 (1.09-1.20)	< 0.001
BUN, mg/dL	0.04	0.00	1.05 (1.04-1.05)	< 0.001
eGFR, mL/(min∙1.73 m-2) (MDRD-4)	0.03	0.01	1.03 (1.02-1.04)	< 0.001
eGFR, mL/(min∙1.73 m-2) (MDRD-6)	-0.03	0.01	0.97 (0.95-0.99)	< 0.001
Albumin, g/dL	-1.24	0.13	0.29 (0.22-0.38)	< 0.001
INR	0.24	0.10	1.27 (1.04-1.54)	0.019

MELD: Model for end-stage liver disease; BUN: Blood urea nitrogen; eGFR: Estimated glomerular filtration rate; MDRD: Modification of diet in renal disease; MDRD-4: 4-variable MDRD; MDRD-6: 6-variable MDRD; CKD-EPI: The chronic kidney disease epidemiology collaboration; INR: International normalized ratio; NS: Not significant.

Table 3 Relationship between estimated glomerular filtration rate, total bilirubin, international normalized ratio and model for end-stage liver disease score as a predictor of in-hospital mortality

Model	Variable	Odds ratio (95% CI)	P value	χ2	-2 Log Likelihood
Model 1	MELD	1.25 (1.23-1.27)	< 0.001	2198.32	2773.90
Model 2	Total bilirubin1	2.25 (2.05-2.48)	< 0.001	2161.45	2810.77
	INR1	6.14 (4.56-8.27)	< 0.001
	eGFR (MDRD-4)1	0.22 (0.20-0.25)	< 0.001
Model 3	Total bilirubin1	2.17 (1.97-2.40)	< 0.001	2293.82	2664.79
	INR1	5.95 (4.39- 8.06)	< 0.001
	eGFR (MDRD-6)1	0.19 (0.17-0.22)	< 0.001
Model 4	Total bilirubin1	2.26 (2.05-2.48)	< 0.001	2199.16	2773.07
	INR1	6.28 (4.65-8.49)	< 0.001
	eGFR (CKD-EPI)1	0.20 (0.18-0.23)	< 0.001

¹Loge value. Statistical comparison was performed with logistic regression analysis. MELD: Model for end-stage liver disease; INR: International normalized ratio; eGFR: Estimated glomerular filtration rate; MDRD: Modification of diet in renal disease; MDRD-4; 4-variable MDRD; MDRD-6: 6-variable MDRD; CKD-EPI: The chronic kidney disease epidemiology collaboration.

Table 4 Comparison of different models for end-stage liver disease equations for the prediction of in-hospital mortality

Equations	Odds ratio (95% CI)	P value	χ2	-2 Log Likelihood
MELD	1.25 (1.23-1.27)	< 0.001	2198.32	2773.90
MELD-MDRD-4	1.27 (1.26-1.29)	< 0.001	2147.93	2824.30
MELD-MDRD-6	1.29 (1.27-1.31)	< 0.001	2254.88	2703.72
MELD-CKD-EPI	1.28 (1.26-1.30)	< 0.001	2185.01	2787.21

Statistical comparison was performed with logistic regression analysis. MELD: Model for end-stage liver disease; MDRD: Modification of diet in renal disease; MDRD-4: 4-variable MDRD; MDRD-6: 6-variable MDRD; CKD-EPI: The chronic kidney disease epidemiology collaboration.

Table 5 The difference between the model for end-stage liver disease and model for end-stage liver disease-modification of diet in renal disease-6 scores of differentially obtained estimated glomerular filtration rate for the prediction of in-hospital mortality

eGFR	Equations	Odds ratio (95% CI)	P value	χ2	-2 Log Likelihood
≥ 90	MELD	1.17 (1.13-1.21)	< 0.001	99.45	609.51
	MELD-MDRD-6	1.20 (1.16-1.24)	< 0.001	114.55	588.67
60-89	MELD	1.22 (1.18-1.26)	< 0.001	185.77	636.17
	MELD-MDRD-6	1.27 (1.22 -1.32)	< 0.001	214.60	606.45
30-59	MELD	1.21 (1.17-1.24)	< 0.001	283.21	755.92
	MELD-MDRD-6	1.26 (1.22-1.30)	< 0.001	312.75	725.22
15-29	MELD	1.25 (1.19-1.30)	< 0.001	163.72	369.37
	MELD-MDRD-6	1.31 (1.24-1.39)	< 0.001	182.49	350.59
< 15	MELD	1.36 (1.27-1.45)	< 0.001	190.62	311.89
	MELD-MDRD-6	1.30 (1.23-1.39)	< 0.001	164.66	337.42

Statistical comparison was performed with logistic regression analysis. MELD: Model for end-stage liver disease; eGFR: Estimated glomerular filtration rate; MDRD: Modification of diet in renal disease; MDRD-4: 4-variable MDRD; MDRD-6: 6-variable MDRD.