Modification of MELD score by including Serum Albumin to improve prediction of mortality outcome of cirrhotic patient based on Thai cirrhotic patients

Nowadays, the Model for End-stage Liver Disease (MELD) has become a popular model and replaced the Child-Pugh score for the assessment of the mortality opportunity of patients with cirrhosis in 3-month period. The model predicts the severity of the disease based on 3 biochemical parameters: serum creatinine, serum total bilirubin, and INR. However, in the past, the first model like Child-Pugh score signified the importance of Serum Albumin, a protein producing in a liver. It is, thus, expected that the Serum Albumin has an effect on patients' mortality prediction. In this research, our main focus is to refine and evaluate the effect of Serum Albumin to mortality of Thai cirrhotic patients if included into the MELD model. We use the data collection from 158 Thai cirrhotic patients with different degrees of severity. They were treated at the Liver Unit and Clinic, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society. The collected data were divided into the periods of 3 months, 6 months, 1 year and 2 years respectively[1]. The Kaplan-Meier statistic was used to analyze the survival opportunity of each period. Also, the Cox-Regression was utilized to evaluate the relationship and the statistical significance of the substance in each period in order to find the connection between the Serum Albumin and mortality opportunities. Results of the study show that of all the data from 158 patients, with the Serum Albumin level between 1.0 and 3.5 g/dL, when tested by Pearson's Chi-squared[2], Log Rank Test and Wilcoxon rank-sum (Mann-Whitney)[3] has the statistical significance at the 1% level of confidence (p <; 0.001). Moreover, the correlation of the results using Cox Regression demonstrated also that Serum Albumin influenced the mortality opportunity at the hazard ratio of 5.14 (95%CI:2.971-8.920) with level of confidence p-value <; 0.0001. Thus, we believe that the Serum Albumin affected the mortality prediction model. We also propose two refined MELD models[4], ThaiMELD-Albumin and ThaiMELD-CTP[5]. For the efficiency assessment of the models, we compare our models to others using the ROC. We found that ThaiMELD-Albumin had 0.85 (95% CI: 0.68-1.00) and it is better than MELD, MELD-Albumin and 5vMELD, while ThaiMELD-CTP is just better than MELD. Consequently, ThaiMELD-Albumin is better for prediction of the mortality opportunity for Thai patients than the MELD, MELD-Albumin or 5vMELD. While ThaiMELD-CTP which just added a scale value to MELD could give a better assessment than MELD itself. Therefore, our model could benefit to Thai patients for the assessment of mortality opportunity as well as symptoms' severity. It could, perhaps, be further used for the consideration of liver transplantation in Thailand.