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MELD 3.0 adequately predicts mortality and renal replacement therapy requirements in patients with alcohol-associated hepatitis

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Title: MELD 3.0 adequately predicts mortality and renal replacement therapy requirements in patients with alcohol-associated hepatitis
Authors: Luis Antonio Díaz, Eduardo Fuentes-López, Gustavo Ayares, Francisco Idalsoaga, Jorge Arnold, María Ayala Valverde, Diego Perez, Jaime Gómez, Rodrigo Escarate, Alejandro Villalón, Carolina A. Ramírez, Maria Hernandez-Tejero, Wei Zhang, Steve Qian, Douglas A. Simonetto, Joseph C. Ahn, Seth Buryska, Winston Dunn, Heer Mehta, Rohit Agrawal, Joaquín Cabezas, Inés García-Carrera, Berta Cuyàs, Maria Poca, German Soriano, Shiv K. Sarin, Rakhi Maiwall, Prasun K. Jalal, Saba Abdulsada, Fátima Higuera-de-la-Tijera, Anand V. Kulkarni, P. Nagaraja Rao, Patricia Guerra Salazar, Lubomir Skladaný, Natália Bystrianska, Ana Clemente-Sanchez, Clara Villaseca-Gómez, Tehseen Haider, Kristina R. Chacko, Gustavo A. Romero, Florencia D. Pollarsky, Juan Carlos Restrepo, Susana Castro-Sanchez, Luis G. Toro, Pamela Yaquich, Manuel Mendizabal, Maria Laura Garrido, Sebastián Marciano, Melisa Dirchwolf, Victor Vargas, César Jiménez, Alexandre Louvet, Guadalupe García-Tsao, Juan Pablo Roblero, Juan G. Abraldes, Vijay H. Shah, Patrick S. Kamath, Marco Arrese, Ashwani K. Singal, Ramon Bataller, Juan Pablo Arab
Source: JHEP Reports, Vol 5, Iss 8, Pp 100727- (2023)
Publisher Information: Elsevier, 2023.
Publication Year: 2023
Collection: LCC:Diseases of the digestive system. Gastroenterology
Subject Terms: End-stage liver disease, Alcoholic hepatitis, Alcohol, Cirrhosis, Female, Outcome prediction, Diseases of the digestive system. Gastroenterology, RC799-869
More Details: 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.
Document Type: article
File Description: electronic resource
Language: English
ISSN: 2589-5559
Relation: http://www.sciencedirect.com/science/article/pii/S2589555923000587; https://doaj.org/toc/2589-5559
DOI: 10.1016/j.jhepr.2023.100727
Access URL: https://doaj.org/article/497553cb7c884b90bbd7340ddb54ae9c
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  Data: 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.
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      – PersonEntity:
          Name:
            NameFull: Kristina R. Chacko
      – PersonEntity:
          Name:
            NameFull: Gustavo A. Romero
      – PersonEntity:
          Name:
            NameFull: Florencia D. Pollarsky
      – PersonEntity:
          Name:
            NameFull: Juan Carlos Restrepo
      – PersonEntity:
          Name:
            NameFull: Susana Castro-Sanchez
      – PersonEntity:
          Name:
            NameFull: Luis G. Toro
      – PersonEntity:
          Name:
            NameFull: Pamela Yaquich
      – PersonEntity:
          Name:
            NameFull: Manuel Mendizabal
      – PersonEntity:
          Name:
            NameFull: Maria Laura Garrido
      – PersonEntity:
          Name:
            NameFull: Sebastián Marciano
      – PersonEntity:
          Name:
            NameFull: Melisa Dirchwolf
      – PersonEntity:
          Name:
            NameFull: Victor Vargas
      – PersonEntity:
          Name:
            NameFull: César Jiménez
      – PersonEntity:
          Name:
            NameFull: Alexandre Louvet
      – PersonEntity:
          Name:
            NameFull: Guadalupe García-Tsao
      – PersonEntity:
          Name:
            NameFull: Juan Pablo Roblero
      – PersonEntity:
          Name:
            NameFull: Juan G. Abraldes
      – PersonEntity:
          Name:
            NameFull: Vijay H. Shah
      – PersonEntity:
          Name:
            NameFull: Patrick S. Kamath
      – PersonEntity:
          Name:
            NameFull: Marco Arrese
      – PersonEntity:
          Name:
            NameFull: Ashwani K. Singal
      – PersonEntity:
          Name:
            NameFull: Ramon Bataller
      – PersonEntity:
          Name:
            NameFull: Juan Pablo Arab
    IsPartOfRelationships:
      – BibEntity:
          Dates:
            – D: 01
              M: 08
              Type: published
              Y: 2023
          Identifiers:
            – Type: issn-print
              Value: 25895559
          Numbering:
            – Type: volume
              Value: 5
            – Type: issue
              Value: 8
          Titles:
            – TitleFull: JHEP Reports
              Type: main
ResultId 1