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

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dc.contributor.authorDíaz, Luis Antonio
dc.contributor.authorFuentes-López, Eduardo
dc.contributor.authorAyares, Gustavo
dc.contributor.authorIdalsoaga, Francisco
dc.contributor.authorArnold, Jorge
dc.contributor.authorAyala Valverde, María
dc.contributor.authorPerez, Diego
dc.contributor.authorGómez, Jaime
dc.contributor.authorEscarate, Rodrigo
dc.contributor.authorVillalón, Alejandro
dc.contributor.authorRamírez, Carolina A.
dc.contributor.authorHernandez-Tejero, Maria
dc.contributor.authorZhang, Wei
dc.contributor.authorQian, Steve
dc.contributor.authorSimonetto, Douglas A.
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.authorGarcía-Carrera, Inés
dc.contributor.authorCuyàs, 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.authorSkladaný, Lubomir
dc.contributor.authorBystrianska, Natália
dc.contributor.authorClemente-Sanchez, 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-Sanchez, Susana
dc.contributor.authorToro, Luis G.
dc.contributor.authorYaquich, Pamela
dc.contributor.authorMendizabal, Manuel
dc.contributor.authorGarrido, Maria Laura
dc.contributor.authorMarciano, Sebastián
dc.contributor.authorDirchwolf, Melisa
dc.contributor.authorVargas, Victor
dc.contributor.authorJiménez, César
dc.contributor.authorLouvet, Alexandre
dc.contributor.authorGarcía-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, Marco
dc.contributor.authorSingal, Ashwani K.
dc.contributor.authorBataller, Ramon
dc.contributor.authorArab, Juan Pablo
dc.date.accessioned2025-10-21T12:31:34Z
dc.date.available2025-10-21T12:31:34Z
dc.date.issued2023
dc.description.abstractBackground & 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 timedependent 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. © 2023 The Author(s). Published by Elsevier B.V. on behalf of European Association for the Study of the Liver
dc.description.sponsorshipFondo Nacional de Desarrollo Científico y Tecnológico, ANID (FONDECYT 1200227 y 1191145 to). National Institute on Alcohol Abuse and Alcoholism, NIAAA U01AA021908 y U01AA020821.
dc.identifier.doi10.1016/j.jhepr.2023.100727
dc.identifier.issn2589-5559
dc.identifier.urihttps://repositorioabierto.uantof.cl/handle/uantof/579
dc.language.isoen
dc.publisherElsevier B.V.
dc.rightsAttribution-NonCommercial-NoDerivatives 4.0 Internationalen
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/4.0/
dc.sourceJournal of Hepatology
dc.subjectEnd-stage liver disease
dc.subjectAlcoholic hepatitis
dc.subjectAlcohol
dc.subjectCirrhosis
dc.subjectFemale
dc.subjectOutcome prediction
dc.subjectMELD
dc.titleMELD 3.0 adequately predicts mortality and renal replacement therapy requirements in patients with alcohol-associated hepatitis
dc.typeArticle
oaire.citation.issue8
oaire.citation.volume5
organization.identifier.rorhttps://ror.org/04eyc6d95
organization.legalNameUniversidad de Antofagasta
uantof.identificator.departmentDepartamento Ciencias Médicas
uantof.identificator.facultyFacultad de Medicina y Odontología
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