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Reply: Clinically relevant differences in the model for end-stage liver disease and model for end-stage liver disease–sodium scores

✍ Scribed by Xavier Xiol; Jose Castellote; Xavier Fuentes-Arderiu

Publisher
John Wiley and Sons
Year
2009
Tongue
English
Weight
37 KB
Volume
15
Category
Article
ISSN
1527-6465

No coin nor oath required. For personal study only.

✦ Synopsis

We thank Garritsen et al. 1 for their interest in our article about differences in Model for End-Stage Liver Disease (MELD) and Model for End-Stage Liver Disease-Sodium (MELD-Na) scores determined at 3 different laboratories. 2 We agree that one of the important messages of our article is the importance of monitoring and maintaining high-quality standards for the measurement of all parameters of MELD and MELD-Na scores. In addition, if organ allocation based on the MELD-Na score is going to be implemented, a comparison of the scores obtained at the laboratories of different hospitals that share cadaveric livers should be made.

With respect to methodology, our study was planned to reproduce the clinical practice of our laboratories. The samples were sent at room temperature because measurements were performed less than 6 hours after extraction. According to approved guidelines for the measurement of bilirubin, creatinine, and sodium serum concentrations, samples may be measured within 24 hours when stored at room temperature. 3 The same can be applied to international normalized ratio measurement. 4 Although enzymatic methods for serum creatinine concentration measurement have been reported to have less interference than the Jaffe method, both enzymatic and "corrected" Jaffe methods may be used for diagnostic purposes. 5 As the 3 laboratories used the Jaffe method, the interference should have been similar.

As for the sodium concentration, the 3% variation found between center A and centers B and C was due to differences in systematic error (bias), which is not a coefficient of variation between the laboratories. In our study, we did not estimate the reproducibility of sodium concentration measurements with the 3 analyzers used because it can be determined from any external quality assessment scheme and it was not necessary for our study.

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