Hyponatremia in Cirrhosis: Comparative Evaluation of MELD and MELD-Na Scores for Predicting Short- and Long-Term Mortality

Abstract Background: Hyponatremia is a frequent complication in patients with liver cirrhosis and is associated with increased morbidity and mortality. The model for end-stage liver disease (MELD) score is commonly used to predict prognosis in cirrhosis, but does not account for serum sodium levels. The MELD-sodium (MELD-Na) score, which incorporates serum sodium, offers improved prognostic accuracy. This study aimed to evaluate and compare the prognostic accuracy of MELD and MELD-Na scores in predicting short- and long-term mortality in patients with cirrhosis. Materials and Methods: This prospective observational study was conducted at a tertiary care hospital. A total of 100 patients with cirrhosis were enrolled, and after excluding those lost to follow-up, 95 patients were analyzed for mortality outcomes at one and 6 months. Patients were categorized based on admission serum sodium levels. MELD and MELD-Na scores were calculated at baseline. Receiver operating characteristic (ROC) curves were used to evaluate predictive performance. Results: Hyponatremia (serum sodium ≤ 135 mmol/L) was present in 47.4% of patients. One-month mortality was highest among those with severe hyponatremia (≤125 mmol/L; 53.8%) and lowest among normonatremic patients (2%). At 6 months, cumulative mortality reached 76.9% in patients with severe hyponatremia. Mean MELD and MELD-Na scores were significantly higher among nonsurvivors compared to survivors at both 1 month (MELD: 32.38 vs. 21.13; MELD-Na: 34.92 vs. 22.82) and 6 months (MELD: 27.32 vs. 18.42; MELD-Na: 30.00 vs. 19.67; P < 0.001 for all). ROC analysis confirmed the superior predictive accuracy of MELD-Na over MELD at 1 month (area under the curve [AUC]: 0.913 vs. 0.898) and 6 months (AUC: 0.904 vs. 0.893; P < 0.001). Conclusion: Hyponatremia is an important prognostic marker in cirrhosis and is associated with higher mortality and complications. The MELD-Na score exceeds MELD in predicting mortality and may be favored for risk stratification and transplant prioritisation in patients with liver cirrhosis.