MELD 3.0 adequately predicts mortality and renal replacement therapy requirements in patients with alcohol-associated hepatitis.
Luis Antonio Díaz
(1)
,
Eduardo Fuentes-López
(1)
,
Gustavo Ayares
(1)
,
Francisco Idalsoaga
(1)
,
Jorge Arnold
(1)
,
María Ayala Valverde
,
Diego Perez
,
Jaime Gómez
,
Rodrigo Escarate
,
Alejandro Villalón
(1)
,
Carolina A. Ramírez
(2)
,
Maria Hernandez-Tejero
(3)
,
Wei Zhang
(4)
,
Steve Qian
(4)
,
Douglas A. Simonetto
(3)
,
Joseph C. Ahn
(3)
,
Seth Buryska
(3)
,
Winston Dunn
(5)
,
Heer Mehta
(5)
,
Rohit Agrawal
(6)
,
Joaquin Cabezas
(7)
,
Inés García-Carrera
(7)
,
Berta Cuyàs
(8)
,
Maria Poca
(9)
,
German Soriano
(9)
,
Shiv K. Sarin
(10)
,
Rakhi Maiwall
(10)
,
Prasun K. Jalal
(11)
,
Saba Abdulsada
(11)
,
Fátima Higuera-De-La-Tijera
(12)
,
Anand V. Kulkarni
(13)
,
P. Nagaraja Rao
(13)
,
Patricia Guerra Salazar
,
Lubomir Skladaný
(14)
,
Natalia Bystrianska
(14)
,
Ana Clemente-Sanchez
(15)
,
Clara Villaseca-Gómez
(15)
,
Tehseen Haider
(16)
,
Kristina R. Chacko
(16)
,
Gustavo A. Romero
(17)
,
Florencia D. Pollarsky
(17)
,
Juan Carlos Restrepo
(18)
,
Susana Castro-Sanchez
(18)
,
Pamela Yaquich
(19)
,
Manuel Mendizabal
(20)
,
Maria Laura Garrido
,
Sebastián Marciano
(21)
,
Melisa Dirchwolf
,
Victor Vargas
(22)
,
César Jiménez
(22)
,
Alexandre Louvet
(23, 24)
,
Juan Pablo Roblero
(25)
,
Juan G. Abraldes
(26)
,
Vijay H. Shah
(3)
,
Patrick S. Kamath
(3)
,
Marco Arrese
(1)
,
Ashwani K. Singal
(27)
,
Ramon Bataller
(28)
,
Juan Pablo Arab
(1, 2)
1
UC -
Pontificia Universidad Católica de Chile
2 UWO - University of Western Ontario
3 Mayo Clinic [Rochester]
4 UF - University of Florida [Gainesville]
5 University of Kansas Medical Center [Kansas City, KS, USA]
6 UIC - University of Illinois [Chicago]
7 Hospital Universitario Marqués de Valdecilla [Santander]
8 UAB - Universitat Autònoma de Barcelona = Autonomous University of Barcelona = Universidad Autónoma de Barcelona
9 Hospital de la Santa Creu i Sant Pau
10 All India Institute of Medical Sciences [New Delhi]
11 BCM - Baylor College of Medicine
12 UNAM - Universidad Nacional Autónoma de México = National Autonomous University of Mexico
13 University of Hyderabad
14 SMU - Slovak Medical University of Bratislava
15 Hospital General Universitario "Gregorio Marañón" [Madrid]
16 Montefiore Medical Center [Bronx, New York]
17 Hospital de Gastroenterología Bonorino Udaondo [Buenos Aires]
18 Universidad de Antioquia = University of Antioquia [Medellín, Colombia]
19 Hospital de San Juan de Dios de Linz
20 Hospital Universitario Austral
21 Italian Hospital of Buenos Aires
22 Vall d'Hebron University Hospital [Barcelona]
23 CHRU Lille - Centre Hospitalier Régional Universitaire [CHU Lille]
24 LIRIC - Lille Inflammation Research International Center - U 995
25 USACH - Universidad de Santiago de Chile [Santiago]
26 University of Alberta
27 Avera Institute for Human Genetics [Sioux Falls]
28 Clinic Barcelona Hospital Universitari
2 UWO - University of Western Ontario
3 Mayo Clinic [Rochester]
4 UF - University of Florida [Gainesville]
5 University of Kansas Medical Center [Kansas City, KS, USA]
6 UIC - University of Illinois [Chicago]
7 Hospital Universitario Marqués de Valdecilla [Santander]
8 UAB - Universitat Autònoma de Barcelona = Autonomous University of Barcelona = Universidad Autónoma de Barcelona
9 Hospital de la Santa Creu i Sant Pau
10 All India Institute of Medical Sciences [New Delhi]
11 BCM - Baylor College of Medicine
12 UNAM - Universidad Nacional Autónoma de México = National Autonomous University of Mexico
13 University of Hyderabad
14 SMU - Slovak Medical University of Bratislava
15 Hospital General Universitario "Gregorio Marañón" [Madrid]
16 Montefiore Medical Center [Bronx, New York]
17 Hospital de Gastroenterología Bonorino Udaondo [Buenos Aires]
18 Universidad de Antioquia = University of Antioquia [Medellín, Colombia]
19 Hospital de San Juan de Dios de Linz
20 Hospital Universitario Austral
21 Italian Hospital of Buenos Aires
22 Vall d'Hebron University Hospital [Barcelona]
23 CHRU Lille - Centre Hospitalier Régional Universitaire [CHU Lille]
24 LIRIC - Lille Inflammation Research International Center - U 995
25 USACH - Universidad de Santiago de Chile [Santiago]
26 University of Alberta
27 Avera Institute for Human Genetics [Sioux Falls]
28 Clinic Barcelona Hospital Universitari
María Ayala Valverde
- Fonction : Auteur
Diego Perez
- Fonction : Auteur
Jaime Gómez
- Fonction : Auteur
Rodrigo Escarate
- Fonction : Auteur
Patricia Guerra Salazar
- Fonction : Auteur
Maria Laura Garrido
- Fonction : Auteur
Melisa Dirchwolf
- Fonction : Auteur
Résumé
Background & Aims
Model for End-Stage Liver Disease (MELD) score better predicts mortality in alcohol-associated hepatitis (AH) but could underestimate severity in women and malnourished patients. Using a global cohort, we assessed the ability of the MELD 3.0 score to predict short-term mortality in AH.
Methods
This was a retrospective cohort study of patients admitted to hospital with AH from 2009 to 2019. The main outcome was all-cause 30-day mortality. We compared the AUC using DeLong's method and also performed a time-dependent AUC with competing risks analysis.
Results
A total of 2,124 patients were included from 28 centres from 10 countries on three continents (median age 47.2 ± 11.2 years, 29.9% women, 71.3% with underlying cirrhosis). The median MELD 3.0 score at admission was 25 (20–33), with an estimated survival of 73.7% at 30 days. The MELD 3.0 score had a better performance in predicting 30-day mortality (AUC:0.761, 95%CI:0.732–0.791) compared with MELD sodium (MELD-Na; AUC: 0.744, 95% CI: 0.713–0.775; p = 0.042) and Maddrey’s discriminant function (mDF) (AUC: 0.724, 95% CI: 0.691–0.757; p = 0.013). However, MELD 3.0 did not perform better than traditional MELD (AUC: 0.753, 95% CI: 0.723–0.783; p = 0.300) and Age-Bilirubin-International Normalised Ratio-Creatinine (ABIC) (AUC:0.757, 95% CI: 0.727–0.788; p = 0.765). These results were consistent in competing-risk analysis, where MELD 3.0 (AUC: 0.757, 95% CI: 0.724–0.790) predicted better 30-day mortality compared with MELD-Na (AUC: 0.739, 95% CI: 0.708–0.770; p = 0.028) and mDF (AUC:0.717, 95% CI: 0.687–0.748; p = 0.042). The MELD 3.0 score was significantly better in predicting renal replacement therapy requirements during admission compared with the other scores (AUC: 0.844, 95% CI: 0.805–0.883).
Conclusions
MELD 3.0 demonstrated better performance compared with MELD-Na and mDF in predicting 30-day and 90-day mortality, and was the best predictor of renal replacement therapy requirements during admission for AH. However, further prospective studies are needed to validate its extensive use in AH.
Impact and implications
Severe AH has high short-term mortality. The establishment of treatments and liver transplantation depends on mortality prediction. We evaluated the performance of the new MELD 3.0 score to predict short-term mortality in AH in a large global cohort. MELD 3.0 performed better in predicting 30- and 90-day mortality compared with MELD-Na and mDF, but was similar to MELD and ABIC scores. MELD 3.0 was the best predictor of renal replacement therapy requirements. Thus, further prospective studies are needed to support the wide use of MELD 3.0 in AH.