{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T07:48:04Z","timestamp":1769500084502,"version":"3.49.0"},"reference-count":19,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"10","license":[{"start":{"date-parts":[[2014,10,1]],"date-time":"2014-10-01T00:00:00Z","timestamp":1412121600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"},{"start":{"date-parts":[[2014,8,26]],"date-time":"2014-08-26T00:00:00Z","timestamp":1409011200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["DK076565"],"award-info":[{"award-number":["DK076565"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2014,10]]},"abstract":"<jats:sec>\n            <jats:title\/>\n            <jats:p>The Model for End-Stage Liver Disease (MELD) score has reduced predictive ability in patients with cirrhosis and MELD scores \u2264 20. We aimed to assess whether a 5-stage clinical model could identify liver transplantation (LT) candidates with low MELD scores who are at increased risk for death. We conducted a case-control study of subjects with cirrhosis and MELD scores \u2264 20 who were awaiting LT at a single academic medical center between February 2002 and May 2011. Conditional logistic regression was used to evaluate the risk of liver-related death according to the cirrhosis stage. We identified 41 case subjects who died from liver-related causes with MELD scores \u2264 20 within 90 days of death while they were waiting for LT. The cases were matched with up to 3 controls (66 controls in all) on the basis of the listing year, age, sex, liver disease etiology, presence of hepatocellular carcinoma, and MELD score. The cirrhosis stage was assessed for all subjects: (1) no varices or ascites, (2) varices, (3) variceal bleeding, (4) ascites, and (5) ascites and variceal bleeding. The MELD scores were similar for cases and controls. Clinical states contributing to death in cases were: sepsis 49%, spontaneous bacterial peritonitis 15%, variceal bleeding 24%, and hepatorenal syndrome 22%. In a univariate analysis, variceal bleeding [odds ratio (OR) = 5.6, <jats:italic toggle=\"yes\">P<\/jats:italic> = 0.003], albumin (OR = 0.5, <jats:italic toggle=\"yes\">P<\/jats:italic> = 0.041), an increasing cirrhosis stage (<jats:italic toggle=\"yes\">P<\/jats:italic> = 0.003), reaching cirrhosis stage 2, 3, or 4 versus lower stages (OR = 3.6, <jats:italic toggle=\"yes\">P<\/jats:italic> = 0.048; OR = 7.4, <jats:italic toggle=\"yes\">P<\/jats:italic> &lt; 0.001; and OR = 4.1, <jats:italic toggle=\"yes\">P<\/jats:italic> = 0.008), a sodium level &lt; 135 mmol\/L (OR = 3.4, <jats:italic toggle=\"yes\">P<\/jats:italic> = 0.006), and hepatic encephalopathy (OR = 2.3, <jats:italic toggle=\"yes\">P<\/jats:italic> = 0.082) were associated with liver-related death. In a multivariate model including the cirrhosis stage, albumin, sodium, and hepatic encephalopathy, an increasing cirrhosis stage (<jats:italic toggle=\"yes\">P<\/jats:italic> = 0.010) was independently associated with liver-related death. In conclusion, assessing the cirrhosis stage in patients with low MELD scores awaiting LT may help to select candidates for more aggressive monitoring or for living or extended criteria donation. <jats:italic toggle=\"yes\">Liver Transpl 20:1193\u20131201, 2014<\/jats:italic>. \u00a9 2014 AASLD.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1002\/lt.23929","type":"journal-article","created":{"date-parts":[[2014,6,10]],"date-time":"2014-06-10T23:50:06Z","timestamp":1402444206000},"page":"1193-1201","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":46,"title":["Stage of Cirrhosis Predicts the Risk of Liver-Related Death in Patients With Low Model for End-Stage Liver Disease Scores and Cirrhosis Awaiting Liver Transplantation"],"prefix":"10.1097","volume":"20","author":[{"given":"Joel","family":"Wedd","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kiran M.","family":"Bambha","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matt","family":"Stotts","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Heather","family":"Laskey","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jordi","family":"Colmenero","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jane","family":"Gralla","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Scott W.","family":"Biggins","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"R1-7-20250124","doi-asserted-by":"crossref","first-page":"211220","DOI":"10.1055\/s-2006-947291","article-title":"MELDbased liver allocation: who is underserved?","volume":"26","author":"Biggins","year":"2006","journal-title":"Semin Liver Dis"},{"key":"R2-7-20250124","first-page":"851858","article-title":"; for UNOSOPTN Liver Disease Severity Score, UNOSOPTN Liver and Intestine, and UNOSOPTN Pediatric Transplantation Committees. The new liver allocation system: moving toward evidencebased transplantation policy.","volume":"8","author":"Freeman","year":"2002","journal-title":"Liver Transpl"},{"issue":"suppl 2","key":"R3-7-20250124","first-page":"A6A22","article-title":"Summary report of a national conference: evolving concepts in liver allocation in the MELD and PELD era. December 8, 2003, Washington, DC, USA.","volume":"10","author":"Olthoff","year":"2004","journal-title":"Liver Transpl"},{"issue":"suppl 3","key":"R4-7-20250124","first-page":"S85S87","article-title":"Model for EndStage Liver Disease (MELD) exception guidelines.","volume":"12","author":"Wiesner","year":"2006","journal-title":"Liver Transpl"},{"key":"R5-7-20250124","first-page":"715","article-title":"; for United Network for Organ Sharing Organ Procurement and Transplantation Network Liver and Transplantation Committee. Results of the first year of the new liver allocation plan.","volume":"10","author":"Freeman","year":"2004","journal-title":"Liver Transpl"},{"key":"R6-7-20250124","doi-asserted-by":"crossref","first-page":"5561","DOI":"10.1111\/j.1478-3231.2005.01190.x","article-title":"Occurrence of cirrhosisrelated complications is a timedependent prognostic predictor independent of baseline Model for EndStage Liver Disease score.","volume":"26","author":"Huo","year":"2006","journal-title":"Liver Int"},{"key":"R7-7-20250124","doi-asserted-by":"crossref","first-page":"129136","DOI":"10.1002\/lt.22218","article-title":"Moderate ascites identifies patients with low Model for EndStage Liver Disease scores awaiting liver transplantation who have a high mortality risk.","volume":"17","author":"Somsouk","year":"2011","journal-title":"Liver Transpl"},{"key":"R8-7-20250124","doi-asserted-by":"crossref","first-page":"802810","DOI":"10.1002\/hep.1840400409","article-title":"Persistent ascites and low serum sodium identify patients with cirrhosis and low MELD scores who are at high risk for early death.","volume":"40","author":"Heuman","year":"2004","journal-title":"Hepatology"},{"key":"R9-7-20250124","first-page":"217231","article-title":"Natural history and prognostic indicators of survival in cirrhosis: a systematic review of 118 studies.","volume":"44","author":"DAmico","year":"2006","journal-title":"J Hepatol"},{"issue":"suppl","key":"R10-7-20250124","first-page":"329A","article-title":"DAmico, C Villanueva, AK Burrohs, MM Dollinger, R Planas, R Sola, et al. AASLD Abstracts.","volume":"52","year":"2010","journal-title":"Hepatology"},{"key":"R11-7-20250124","doi-asserted-by":"crossref","first-page":"10181026","DOI":"10.1056\/NEJMoa0801209","article-title":"Hyponatremia and mortality among patients on the livertransplant waiting list.","volume":"359","author":"Kim","year":"2008","journal-title":"N Engl J Med"},{"key":"R12-7-20250124","doi-asserted-by":"crossref","first-page":"258266","DOI":"10.1053\/jhep.2003.50315","article-title":"The management of ascites in cirrhosis: report on the consensus conference of the International Ascites Club.","volume":"38","author":"Moore","year":"2003","journal-title":"Hepatology"},{"key":"R13-7-20250124","first-page":"397417","article-title":"EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis.","volume":"53","year":"2010","journal-title":"J Hepatol"},{"key":"R14-7-20250124","doi-asserted-by":"crossref","first-page":"13101324","DOI":"10.1016\/j.jhep.2014.01.024","article-title":"Bacterial infections in cirrhosis. a position statement based on the EASL special conference 2013.","volume":"60","author":"Jalan","year":"2014","journal-title":"J Hepatol"},{"key":"R15-7-20250124","doi-asserted-by":"crossref","first-page":"307313","DOI":"10.1111\/j.1600-6143.2004.00703.x","article-title":"The survival benefit of liver transplantation.","volume":"5","author":"Merion","year":"2005","journal-title":"Am J Transplant"},{"key":"R16-7-20250124","doi-asserted-by":"crossref","first-page":"14071414","DOI":"10.1111\/j.1478-3231.2012.02830.x","article-title":"Prognostic indicators of survival in patients with compensated and decompensated cirrhosis.","volume":"32","author":"Zipprich","year":"2012","journal-title":"Liver Int"},{"key":"R17-7-20250124","doi-asserted-by":"crossref","first-page":"16521660","DOI":"10.1053\/j.gastro.2006.02.010","article-title":"Evidencebased incorporation of serum sodium concentration into MELD.","volume":"130","author":"Biggins","year":"2006","journal-title":"Gastroenterology"},{"key":"R18-7-20250124","doi-asserted-by":"crossref","first-page":"3239","DOI":"10.1002\/hep.20517","article-title":"Serum sodium predicts mortality in patients listed for liver transplantation.","volume":"41","author":"Biggins","year":"2005","journal-title":"Hepatology"},{"key":"R19-7-20250124","doi-asserted-by":"crossref","first-page":"336343","DOI":"10.1002\/lt.20329","article-title":"Addition of serum sodium into the MELD score predicts waiting list mortality better than MELD alone.","volume":"11","author":"Ruf","year":"2005","journal-title":"Liver Transpl"}],"container-title":["Liver Transplantation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Flt.23929","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Flt.23929","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.lww.com\/01445473-201410000-00007","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,1,24]],"date-time":"2025-01-24T17:33:58Z","timestamp":1737740038000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/01445473-201410000-00007"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2014,10]]},"references-count":19,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2014]]}},"URL":"https:\/\/doi.org\/10.1002\/lt.23929","relation":{},"ISSN":["1527-6465"],"issn-type":[{"value":"1527-6465","type":"print"}],"subject":[],"published":{"date-parts":[[2014,10]]}}}