engleski

The impact of different methods of creatinine measurements on MELD scoring system

Background. The Model for End-Stage Liver Disease (MELD) scoring system is used to prioritize patients for liver transplantation by their disease severity based on three laboratory parameters: serum creatinine and bilirubin concentrations and INR prothrombin ratio. The aim of this study was to investigate impact of two different creatinine methods on MELD score. Materials and methods. We assessed 40 blood samples obtained from 32 patients listed for liver transplantation. Serum creatinine concentrations were measured by the kinetic Jaffe method (Beckman Coulter OSR6178) traceable to NIST SRM 909b level 2 and enzymatic method (Beckman Coulter OSR61204) traceable to the IDMS method and SRM 967. The MELD csore was calculated according to the formula currently in use by Eurotransplant. Patients are stratified in a descening order starting with the highest MELD. Results. There was a significant difference in serum creatinine among Jaffe and enzymatic methods: median 93 (range 67-744) vs. 73, 5 (range 49-747) umol/L, respectively. The variation in creatinine measurements resulted in differences up to 2 points in a single patients. When the enzymatic method was used instead of Jaffe method, MELD scores were unchanged in 23 cases whereas in 17 cases MELD scores decreased by 1-2 point. Conclusion. Observed variability in the assessment of the MELD score due to methodological variation in serum creatinine measurement may not significantly alter prognosis or have clinical consequences but may affect prioritization for liver transplantation. For this reason standardization of creatinine measurements using specific enzymatic method traceable to SRM 967 is of most importance.

creatinine measurement ; MELD scoring

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