UK - Different methods of creatinine measurement significantly affect MELD scores

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Different methods of creatinine

measurement significantly affect MELD scores

Evangelos Cholongitas,

Marelli, Kerry, Marco Senzolo,

W. Goodier, Devaki

Nair, , Patch, K. Burroughs

Liver Transplantation and Hepatobiliary

Medicine Unit, London, UK

23 Feb 2007

Abstract

Bilirubin (Bil) interferes

with creatinine (Cr) measurement.

Different laboratory methods are used to overcome this problem. Model for end-stage liver disease (MELD) scoring

incorporates Cr and is used to prioritize patients for liver transplantation. Thus, MELD scores may vary with different Cr

measurements influencing patients' priority. Our aim

was to evaluate 4 different Cr assays (O'Leary modified Jaffe [mJCr], compensated [rate blanked] kinetic Jaffe [cJCr], enzymatic [ECr], and

standard kinetic Jaffe [JCr]) in patients with

abnormal liver function tests and assess changes in MELD score. A total of 403 consecutive samples from 158 patients' Cr

assays were evaluated.. Bland-Altman plots and MELD

scores were also evaluated for each assay. Agreement

was found to be poor among all Cr assays. Increased

variability in Cr occurred with increasing Bil

concentrations: Bil <100 mol/L 3-point MELD variation -

3-point difference in 2%; Bil 400mol/L 7-point MELD variation - 3-point difference in 78%.

When MELD was 25 (mJCr

as reference; mean, 30.5 points), MELD variation was greatest: mean, 28 (MELD

cJCr), 27.5 (MELD ECr),

and 28.4 (MELD JCr) (P < 0.001). In conclusion,

there is poor agreement among different assays for Cr. As

Bil concentration rises, there is greater

variability in each creatinine measurements and

thus greater variability in MELD scores that, this affect prioritization for

liver transplantation.

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