Re: UK - Different methods of creatinine measurement significantly affect MELD s

[Guest guest]

This abstract looks like it underscores a point I've been making. My

understanding is that since creatinine isn't high in PSC patients

until very late in the game, and since bili (which is the real bad

factor for PSC patients) tends to be high, MELD has a natural bias

against PSC patients.

In my case, bili hovers between 2 and 3, with creatinine and INR way

down. My MELD thus fluctuates between 7 and about 10, which puts me

about 14,000th in line.

Maybe the living donor route is the way to go for us.

>

>

> 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.

>

> Barb in Texas - Together in the Fight, Whatever it Takes!

> Son Ken (32) UC 91 - PSC 99 Listed 7/21 @ Baylor Dallas

>