Guest guest Posted May 19, 2006 Report Share Posted May 19, 2006 wrote: > > ..... MELD score and Na, at listing, were significant > (both, P < .01) predictors of death within 6 months. After > adjustment for MELD score and center, there was a linear increase in > the risk of death as Na decreased between 135 and 120 mEq/L. A new > score to incorporate Na into MELD was developed: " MELD-Na " = MELD + > 1.59 (135 - Na) with maximum and minimum Na of 135 and 120 mEq/L, > respectively. , please tell me if I'm understanding this equation correctly (my serum sodium is 126, and my current MELD is around 11 or 12): Current MELD + 1.59(135-126) = new " MELD-NA " score 12 + 1.59(9) = new " MELD-NA " Score 12 + 14.31 = new " MELD-NA " Score 26.31 = my new " MELD-NA " score? This would shoot my MELD from 12 to 26???? I've read your e-mail over about 20 times trying to grasp it and get the details to stick in my mind and I think I've got it, but am I right???? TO THE REST OF THE GROUP -- Please, please post your serum sodium value. Surely I'm not the lowest on in the whole bunch of us. This is a bit unsettling, to say the least. Regards, Carolyn B. in SC Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 19, 2006 Report Share Posted May 19, 2006 wrote: > > ..... MELD score and Na, at listing, were significant > (both, P < .01) predictors of death within 6 months. After > adjustment for MELD score and center, there was a linear increase in > the risk of death as Na decreased between 135 and 120 mEq/L. A new > score to incorporate Na into MELD was developed: " MELD-Na " = MELD + > 1.59 (135 - Na) with maximum and minimum Na of 135 and 120 mEq/L, > respectively. , please tell me if I'm understanding this equation correctly (my serum sodium is 126, and my current MELD is around 11 or 12): Current MELD + 1.59(135-126) = new " MELD-NA " score 12 + 1.59(9) = new " MELD-NA " Score 12 + 14.31 = new " MELD-NA " Score 26.31 = my new " MELD-NA " score? This would shoot my MELD from 12 to 26???? I've read your e-mail over about 20 times trying to grasp it and get the details to stick in my mind and I think I've got it, but am I right???? TO THE REST OF THE GROUP -- Please, please post your serum sodium value. Surely I'm not the lowest on in the whole bunch of us. This is a bit unsettling, to say the least. Regards, Carolyn B. in SC Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 20, 2006 Report Share Posted May 20, 2006 Dear Carolyn; Your calculations look to be perfectly correct! It looks like it can have a huge effect on the score. Best regards, Dave (father of (20); PSC 07/03; UC 08/03) > , please tell me if I'm understanding this equation correctly (my > serum sodium is 126, and my current MELD is around 11 or 12): > This would shoot my MELD from 12 to 26???? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 20, 2006 Report Share Posted May 20, 2006 Dear Carolyn; Your calculations look to be perfectly correct! It looks like it can have a huge effect on the score. Best regards, Dave (father of (20); PSC 07/03; UC 08/03) > , please tell me if I'm understanding this equation correctly (my > serum sodium is 126, and my current MELD is around 11 or 12): > This would shoot my MELD from 12 to 26???? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 20, 2006 Report Share Posted May 20, 2006 > > , please tell me if I'm understanding this equation correctly > (my > serum sodium is 126, and my current MELD is around 11 or 12): > > This would shoot my MELD from 12 to 26???? > I think one thing to keep in mind is that using this equation would have a very large effect on score but at the same time most everyone else currently waiting for transplant might see similar jumps in MELD score, at least all those with Ascites. This will cause an overall jump in average MELD score at transplantation. In todays MELD model we may think a high meld for someone approaching transplant might be a 20 for example but under the new model you might need something like a 28 to be near the top of list (These are simply random numbers I picked for this example). So in Carolyn's case even though her MELD would go from a 12 to a 26, many other patients currently listed ahead of her would see similar jumps. And the top MELD score would probably not be a 40 like it is now but more like a 60+. in Seattle Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 20, 2006 Report Share Posted May 20, 2006 I think I missed what makes serum sodium drop? What causes ascites? If serum sodium is a sign of kidney problems, then wouldn't this shift MELD further toward prioritizing hepatorenal syndrome? Not that I oppose it, but it seems like there have to be provisions for extra points for those with recurrent infections, and the other life-threatening things that MELD doesn't take into account at present. Martha (MA) > > > > > , please tell me if I'm understanding this equation > correctly > > (my > serum sodium is 126, and my current MELD is around 11 or 12): > > > This would shoot my MELD from 12 to 26???? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 20, 2006 Report Share Posted May 20, 2006 I think I missed what makes serum sodium drop? What causes ascites? If serum sodium is a sign of kidney problems, then wouldn't this shift MELD further toward prioritizing hepatorenal syndrome? Not that I oppose it, but it seems like there have to be provisions for extra points for those with recurrent infections, and the other life-threatening things that MELD doesn't take into account at present. Martha (MA) > > > > > , please tell me if I'm understanding this equation > correctly > > (my > serum sodium is 126, and my current MELD is around 11 or 12): > > > This would shoot my MELD from 12 to 26???? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 20, 2006 Report Share Posted May 20, 2006 I think I missed what makes serum sodium drop? What causes ascites? If serum sodium is a sign of kidney problems, then wouldn't this shift MELD further toward prioritizing hepatorenal syndrome? Not that I oppose it, but it seems like there have to be provisions for extra points for those with recurrent infections, and the other life-threatening things that MELD doesn't take into account at present. Martha (MA) > > > > > , please tell me if I'm understanding this equation > correctly > > (my > serum sodium is 126, and my current MELD is around 11 or 12): > > > This would shoot my MELD from 12 to 26???? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 20, 2006 Report Share Posted May 20, 2006 > (my serum sodium is 126, and my current MELD is around 11 or 12): > > Current MELD + 1.59(135-126) = 26.31 = my new " MELD-NA " score? > > This would shoot my MELD from 12 to 26???? > > TO THE REST OF THE GROUP -- Please, please post your serum sodium value. > Regards, > Carolyn B. in SC The proposed change would add 23 points to current MELD scores for those with sodium levels of 120 or less. My MELD of 20 would not change since my sodium level is 138 (as of April). It has been between 137 and 145 for the last 6 years, and never a concern. Tim R Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 20, 2006 Report Share Posted May 20, 2006 Martha wrote: > I think I missed what makes serum sodium drop? Martha, I was wondering the same thing. The first hint I had that it must be serious was when my dr. took one look at the lab sheet and began moving super-fast for additional lab work! Second was the item posted about how it would affect the MELD. Until then, I hadn't realized it might go along with the end stage of liver failure. After searching for answers and finding lots of sites which my foggy HE brain couldn't make sense of, I found this article which makes it a good bit plainer: http://www.healthandage.com/default.cfm?curr_navi=07 & curr_content=07 & spr=en & fram\ edef=1 & curr_paramlist=healthandage;79;7;haa_online_from;2;1;3;-;dsp_tooldetail Also, I learned that serum sodium drops in many other serious chronic illnesses. In heart failure, those patients with subnormal serum sodium levels experience double the death rate of heart failure patients with normal serum sodium levels. Obviously, pretty serious stuff here! Regards, Carolyn B. in SC Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 20, 2006 Report Share Posted May 20, 2006 Martha wrote: > I think I missed what makes serum sodium drop? What causes ascites? Sorry ... forgot to address your 2nd question! Go to: http://www.gi.org/patients/gihealth/ascites.asp Regards, Carolyn B. in SC Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 20, 2006 Report Share Posted May 20, 2006 Martha wrote: > I think I missed what makes serum sodium drop? What causes ascites? Sorry ... forgot to address your 2nd question! Go to: http://www.gi.org/patients/gihealth/ascites.asp Regards, Carolyn B. in SC Quote Link to comment Share on other sites More sharing options...
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