Model for end-stage liver disease-Na score or Maddrey discrimination function index, which score is best?

Table 1 Univariate analysis between survived and deceased patients at 30 d

Variables	Survived (n = 29)	Deceased (n = 23)	P
Demographic
Age (yr)	40 ± 9.6	44 ± 12	0.114
Alcohol consumption per day (g/d)	291 ± 140	302 ± 159	0.809
Male, n (%)	28 (97)	20 (87)	0.222
Laboratory parameters at admission
White blood cell counts (103/μL)	17362 ± 9807	21772 ± 10131	0.11
Glucose (mg/dL)	102 ± 49	102 ± 61	0.987
Sodium (mmol/L)	132 ± 6	128 ± 6	0.019a
Total bilirubin (mg/dL)	17.3 ± 8.9	23.6 ± 9.4	0.018a
AST (IU/L)	172 ± 111	189 ± 93	0.55
ALT (IU/L)	66.9 ± 40.5	71.5 ± 33	0.66
γGT (IU/L)	369 ± 254	291 ± 183	0.282
Alkaline phosphatase (IU/L)	254 ± 109	222 ± 112	0.344
Creatinine (mg/dL)	1.61 ± 1.5	3.5 ± 2.5	0.001a
INR	2.05 ± 0.6	2.49 ± 1.48	0.079
Prothrombin time (s)	23.14 ± 8.1	27.2 ± 11.2	0.142
Albumin (mg/dL)	2.8 ± 0.5	2.5 ± 0.6	0.73
Cholesterol (mg/dL)	150.8 ± 68	116 ± 53	0.081
Triglycerides (mg/dL)	222 ± 122	230 ± 178	0.869
Calcium (mg/dL)	7.9 ± 0.7	7.5 ± 1.1	0.10
Clinical manifestations at admission
Ascites, n (%)	25 (86)	22 (95)	0.468
Child status			0.023a
Grade B, n (%)	6 (20)	0
Grade C, n (%)	23 (80)	23 (100)
Encephalophaty, n (%)			0.335
None	13 (45)	7 (30)
Stage I	4 (14)	5 (22)
Stage II	8 (28)	10 (43)
Stage III	4 (14)	1 (4)
Hepatorenal syndrome, n (%)	5 (17)	14 (61)	0.001a
Severity of liver disease at admission
MELD-Na score	25.5 ± 8	31.9 ± 6	0.003a
Maddrey DFI	69.4 ± 42	93 ± 53.8	0.08
MELD	32.1 ± 6.5	25.1 ± 2.9	0.79

^aP < 0.05 vs survived patients at 30 d. MELD: Model for end-stage liver disease; DFI: Discrimination function index; INR: International normalized ratio; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; γGT: Gamma glutamyl transpeptidase.

Table 2 Univariate analysis between survived and deceased patients at 90 d

Variables	Survived (n = 22)	Deceased (n = 30)	P
Demographic
Age (yr)	41 ± 9	44 ± 11	0.27
Alcohol consumption per day (g/d)	284 ± 148	303 ± 143	0.584
Male, n (%)	21 (95)	27 (90)	0.94
Laboratory parameters at admission
White blood cell counts (103 /μL)	284 ± 148	303 ± 143	0.584
Glucose (mg/dL)	108 ± 59	99 ± 49	0.55
Sodium (mmol/L)	133 ± 5	129 ± 6	0.03a
Total bilirubin (mg/dL)	16 ± 8	22 ± 10	0.009a
AST (IU/L)	192 ± 137	177 ± 84	0.61
ALT (IU/L)	103 ± 150	67 ± 39	0.24
γGT (IU/L)	577 ± 656	399 ± 480	0.29
Alkaline phosphatase (IU/L)	281 ± 91	211 ± 105	0.01a
Creatinine (mg/dL)	2 ± 1.8	3 ± 2.11	0.01a
INR	2 ± 0.4	3 ± 1.3	0.002a
Prothrombin time (s)	19 ± 4	28 ± 12	0.0003a
Albumin (mg/dL)	3 ± 0.5	3 ± 5	0.54
Cholesterol (mg/dL)	176 ± 90	119 ± 51	0.01a
Triglycerides (mg/dL)	240 ± 163	226 ± 162	0.76
Calcium (mg/dL)	7.9 ± 0.8	7.3 ± 1.5	0.28
Clinical manifestations at admission
Ascites, n (%)	19 (86)	28 (93)	0.71
Child status			0.05a
Grade B, n (%)	8 (37)	3 (10)
Grade C, n (%)	14 (63)	27 (90)
Encephalophaty, n (%)	0 (0)
None	10 (45)	0 (30)	0.106
Stage I	8 (37)	3 (10)
Stage II	4 (18)	19(63)
Stage III		8 (26)
Hepatorrenal syndrome, n (%)	5 (22)	16 (53)	0.05a
Severity of liver disease at admission
MELD-Na score	24.95 ± 8	30.9 ± 7.79	0.01a
Maddrey DFI	68.5 ± 42	88.3 ± 48.6	0.12
MELD	22.1 ± 7.5	23.1 ± 3.1	0.28

^aP < 0.05 vs survived patients at 90 d. MELD: Model for end-stage liver disease; DFI: Discrimination function index; INR: International normalized ratio; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; γGT: Gamma glutamyl transpeptidase.

Table 3 Variables with significance in the multivariate logistic regression analysis

	Significance	Odds ratio	95%CI
30-d mortality
MELD-Na	0.11	1.25	0.78-1.7
Maddrey DFI	0.14	1.14	0.82-3.04
Bilirubin	0.45	0.7	0.47-3.6
Creatinine	0.38	0.31	0.74-1.98
INR	0.41	0.78	0.68-1.52
Hepatorenal syndrome	0.001	11.5	2.7-48.11
90-d mortality
MELD-Na	0.036	1.19	1.06-1.232
Maddrey DFI	0.09	1.03	0.87-1.86
Bilirubin	0.23	0.67	0.65-3.56
Creatinine	0.35	0.37	0.8-4.2
INR	0.17	0.272	0.78-2.6

MELD: Model for end-stage liver disease; DFI: Discrimination function index; INR: International normalized ratio.

Table 4 Clinical utility analysis at 30 and 90 d to predict mortality %

	Sensitivity	Specificity	Positive predictive value	Negative predictive value	Accuracy
Maddrey DFI > 32
Mortality at day 30	96	21	53	86	57
Mortality at day 90	93	22.7	62.2	71.4	63.5
MELD-Na > 21
Mortality at day 30	85	31	53	69	57.1
Mortality at day 90	87	40	66	69	67.3

MELD: Model for end-stage liver disease; DFI: Discrimination function index.