A likely explanation is the greater dilutional effect from the long-lasting volume expansion induced by colloid preloading compared with crystalloid co-loading.
According to the computed comparison of MELD/MELD-Na score, whenever Na concentration exceeds 137 mmol/L, MELD-Na score, and MELD score are even.[16],[17] Prior studies revealed that dilutional hyponatremia was a frequent event in cirrhotic patients with ascites, so MELD-Na score could predict mortality among those patients more accurately than MELD score alone.[12],[13],[14],[15] In this ongoing study, we documented that preoperative MELD score was the independent risk factor for the occurrence of AKI post-OLT, instead of MELD-Na score.
The use of serum creatinine as a prognostic marker may be misleading due to several factors, including loss of muscle mass, decreased production of creatinine due to inflammation, and a dilutional effect from iatrogenic volume overload.
In late 2012, one of the authors (DS) started to observe unexpected results when testing patients for inhalant allergens with the Intradermal Dilutional Test (IDT) even though no changes in testing protocols or personnel had occurred.
In addition, the exposure of blood to CPB circuit and its dilutional effect results in altered coagulability which cannot be accurately reversed by protamine.
Potential explanations for this type of discordant testing results include the presence of an inhibitor of the PCR reaction and/or dilutional effects with BAL collection in patients with low PCP burden despite the high diagnostic sensitivity of BAL PCP real-time PCR testing [3].
One patient in study group had acute urinary retention and one had dilutional hypocalcaemia that could be attributed to longer procedure time; however it was statistically nonsignificant.