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

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dc.article.number100727
dc.catalogadorvzp
dc.contributor.authorDiaz Piga, Luis Antonio
dc.contributor.authorFuentes Lopez, Eduardo
dc.contributor.authorAyares Campos, Gustavo Ignacio
dc.contributor.authorIdalsoaga Ferrer, Francisco Javier
dc.contributor.authorArnold Álvarez, Jorge Ignacio
dc.contributor.authorValverde, María Ayala
dc.contributor.authorPerez, Diego
dc.contributor.authorGómez, Jaime
dc.contributor.authorEscarate, Rodrigo
dc.contributor.authorVillalon Friedrich, Alejandro Andrés
dc.contributor.authorRamírez, Carolina A.
dc.contributor.authorHernández-Tejero, María
dc.contributor.authorZhang, Wei
dc.contributor.authorQian, Steve
dc.contributor.authorSimonetto, Douglas
dc.contributor.authorAhn, Joseph C.
dc.contributor.authorBuryska, Seth
dc.contributor.authorDunn, Winston
dc.contributor.authorMehta, Heer
dc.contributor.authorAgrawal, Rohit
dc.contributor.authorCabezas, Joaquín
dc.contributor.authorGarcia Carrera, Inés
dc.contributor.authorCuyas, Berta
dc.contributor.authorPoca, Maria
dc.contributor.authorSoriano, German
dc.contributor.authorSarin, Shiv K.
dc.contributor.authorMaiwall, Rakhi
dc.contributor.authorJalal, Prasun K.
dc.contributor.authorAbdulsada, Saba
dc.contributor.authorHiguera de la Tijera, Fátima
dc.contributor.authorKulkarni, Anand V.
dc.contributor.authorRao, P. Nagaraja
dc.contributor.authorGuerra Salazar, Patricia
dc.contributor.authorSkladany, Lubomir
dc.contributor.authorBystrianska, Natália
dc.contributor.authorClemente Sánchez, Ana
dc.contributor.authorVillaseca Gómez, Clara
dc.contributor.authorHaider, Tehseen
dc.contributor.authorChacko, Kristina R.
dc.contributor.authorRomero, Gustavo A.
dc.contributor.authorPollarsky Florencia D.
dc.contributor.authorRestrepo, Juan Carlos
dc.contributor.authorCastro Sánchez, Susan
dc.contributor.authorToro, Luis G.
dc.contributor.authorYaquich, Pamela
dc.contributor.authorMendizabal, Manuel
dc.contributor.authorGarrido, María Laura
dc.contributor.authorMarciano, Sebastián
dc.contributor.authorDirchwolf, Melisa
dc.contributor.authorVargas, Víctor
dc.contributor.authorJimenez, César
dc.contributor.authorLouvet, Alexandre
dc.contributor.authorGarcia Tsao, Guadalupe
dc.contributor.authorRoblero, Juan Pablo
dc.contributor.authorAbraldes, Juan G.
dc.contributor.authorShah, Vijay H.
dc.contributor.authorKamath, Patrick S.
dc.contributor.authorArrese Jimenez, Marco Antonio
dc.contributor.authorSingal, Ashwani K.
dc.contributor.authorBataller, Ramón
dc.contributor.authorArab Verdugo, Juan Pablo
dc.date.accessioned2024-01-29T15:48:50Z
dc.date.available2024-01-29T15:48:50Z
dc.date.issued2023
dc.description.abstract© 2023 The Author(s)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.
dc.description.funderNIAAA
dc.description.funderFONDECYT
dc.format.extent8 páginas
dc.fuente.origenScopus
dc.identifier.doi10.1016/j.jhepr.2023.100727
dc.identifier.eissn2589-5559
dc.identifier.issn25895559
dc.identifier.scopusidSCOPUS_ID:85165989420
dc.identifier.urihttps://repositorio.uc.cl/handle/11534/81003
dc.identifier.wosidWOS:001051851400001
dc.information.autorucEscuela de Medicina; Diaz Piga, Luis Antonio; S/I; 179253
dc.information.autorucEscuela de Medicina; Fuentes López, Eduardo; 0000-0002-0141-0226; 1013849
dc.information.autorucEscuela de Medicina; Ayares Campos, Gustavo Ignacio; S/I; 1033904
dc.information.autorucEscuela de Medicina; Idalsoaga Ferrer, Francisco Javier; S/I; 1017394
dc.information.autorucEscuela de Medicina; Arnold Álvarez, Jorge Ignacio; S/I; 1148388
dc.information.autorucEscuela de Medicina; Villalon Friedrich, Alejandro Andras; S/I; 237951
dc.information.autorucEscuela de Medicina; Arrese Jimenez, Marco Antonio; 0000-0002-0499-4191; 76095
dc.information.autorucEscuela de Medicina; Arab Verdugo, Juan Pablo; 0000-0002-8561-396X; 132745
dc.issue.numero8
dc.language.isoen
dc.nota.accesoContenido parcial
dc.pagina.final8
dc.pagina.inicio1
dc.publisherElsevier B.V.
dc.revistaJHEP Reports
dc.rightsacceso restringido
dc.subjectAlcohol
dc.subjectAlcoholic hepatitis
dc.subjectCirrhosis
dc.subjectEnd-stage liver disease
dc.subjectFemale
dc.subjectMELD
dc.subjectOutcome prediction
dc.subject.ddc610
dc.subject.deweyMedicina y salud
dc.subject.ods03 Good health and well-being
dc.subject.odspa03 Salud y bienestar
dc.titleMELD 3.0 adequately predicts mortality and renal replacement therapy requirements in patients with alcohol-associated hepatitis
dc.typeartículo
dc.volumen5
sipa.codpersvinculados179253
sipa.codpersvinculados1013849
sipa.codpersvinculados1033904
sipa.codpersvinculados1017394
sipa.codpersvinculados1148388
sipa.codpersvinculados237951
sipa.codpersvinculados76095
sipa.codpersvinculados132745
sipa.trazabilidadSCOPUS;2023-08-23
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