MELD 3.0 adequately predicts mortality and renal replacement therapy requirements in patients with alcohol-associated hepatitis
Díaz, Luis Antonio (Pontificia Universidad Católica de Chile)
Fuentes-López, Eduardo (Pontificia Universidad Católica de Chile)
Ayares, Gustavo (Pontificia Universidad Católica de Chile)
Idalsoaga, Francisco (Pontificia Universidad Católica de Chile)
Arnold, Jorge (Pontificia Universidad Católica de Chile)
Valverde, María Ayala (Hospital El Pino)
Perez, Diego (Hospital El Pino)
Gómez, Jaime (Hospital El Pino)
Escarate, Rodrigo (Hospital El Pino)
Villalón, Alejandro (Universidad de Antofagasta)
Ramírez, Carolina A. (Western University)
Hernandez-Tejero, Maria (Hospital Clínic i Provincial de Barcelona)
Zhang, Wei (Massachusetts General Hospital)
Qian, Steve (University of Florida)
Simonetto, Douglas A. (Mayo Clinic)
Ahn, Joseph C. (Mayo Clinic)
Buryska, Seth (Mayo Clinic)
Dunn, Winston (University of Kansas Medical Center)
Mehta, Heer (University of Kansas Medical Center)
Agrawal, Rohit (University of Illinois)
Cabezas, Joaquín (Instituto de Investigación Valdecilla (IDIVAL))
García-Carrera, Inés (Instituto de Investigación Valdecilla (IDIVAL))
Cuyàs, Berta (Institut d'Investigació Biomèdica Sant Pau)
Poca Sans, Maria (Institut d'Investigació Biomèdica Sant Pau)
Soriano, German (Institut d'Investigació Biomèdica Sant Pau)
Sarin, Shiv K. (Institute of Liver and Biliary Sciences)
Maiwall, Rakhi (Institute of Liver and Biliary Sciences)
Jalal, Prasun K. (Baylor College of Medicine)
Abdulsada, Saba (Baylor College of Medicine)
Higuera-de-la-Tijera, Fátima (Universidad Nacional Autónoma de México)
Kulkarni, Anand V. (Asian Institute of Gastroenterology)
Rao, P. Nagaraja (Asian Institute of Gastroenterology)
Salazar, Patricia Guerra (Instituto de Gastroenterología Boliviano-Japonés)
Skladaný, Lubomir (Slovak Medical University)
Bystrianska, Natália (Slovak Medical University)
Clemente-Sanchez, Ana (CIBERehd Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas Madrid)
Villaseca-Gómez, Clara (CIBERehd Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas Madrid)
Haider, Tehseen (Montefiore Medical Center)
Chacko, Kristina R. (Montefiore Medical Center)
Romero, Gustavo A. (Hospital de Gastroenterología Dr. Carlos Bonorino Udaondo)
Pollarsky, Florencia D. (Hospital de Gastroenterología Dr. Carlos Bonorino Udaondo)
Restrepo, Juan Carlos (Unidad de Hepatología del Hospital Pablo Tobon Uribe)
Castro-Sanchez, Susana (Grupo de Gastrohepatología de la Universidad de Antioquia)
Toro, Luis G. (Hospitales de San Vicente Fundación de Medellín y Rionegro)
Yaquich, Pamela (Hospital San Juan de Dios)
Mendizabal, Manuel (Hospital Universitario Austral)
Garrido, Maria Laura (Hospital Central Dr. Ramon Carrillo)
Marciano, Sebastián (Hospital Italiano de Buenos Aires (Argentina))
Dirchwolf, Melisa (Hospital Privado de Rosario)
Vargas Blasco, Víctor (Hospital Universitari Vall d'Hebron)
Jiménez, Cesar (Hospital Universitari Vall d'Hebron)
Louvet, Alexandre (Hôpital Claude Huriez)
García-Tsao, Guadalupe (Yale University School of Medicine/VA-CT Healthcare System)
Roblero, Juan Pablo (Hospital Clínico Universidad de Chile)
Abraldes, Juan G. (University of Alberta)
Shah, Vijay H. (Mayo Clinic)
Kamath, Patrick S. (Mayo Clinic)
Arrese, Marco (Pontificia Universidad Católica de Chile)
Singal, Ashwani K. (Avera Transplant Institute)
Bataller, Ramon (Hospital Clínic i Provincial de Barcelona)
Arab, Juan Pablo (Western University)
Universitat Autònoma de Barcelona

Data:	2023
Resum:	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. 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. 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). 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. 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.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, i la comunicació pública de l'obra, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. No es permet la creació d'obres derivades.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Alcoholic hepatitis ; Alcohol ; Cirrhosis ; End-stage liver disease ; Female ; MELD ; Outcome prediction
Publicat a:	JHEP Reports, Vol. 5 (march 2023) , ISSN 2589-5559

DOI: 10.1016/j.jhepr.2023.100727
PMID: 37456675

9 p, 1.1 MB

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