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

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dc.contributor.authorLuis Antonio Díaz
dc.contributor.authorEduardo Fuentes-López
dc.contributor.authorGustavo Ayares
dc.contributor.authorFrancisco Idalsoaga
dc.contributor.authorJorge Arnold
dc.contributor.authorMaría Ayala Valverde
dc.contributor.authorDiego Perez
dc.contributor.authorJaime Gómez
dc.contributor.authorRodrigo Escarate
dc.contributor.authorAlejandro Villalón
dc.contributor.authorCarolina A. Ramírez
dc.contributor.authorMaria Hernandez-Tejero
dc.contributor.authorWei Zhang
dc.contributor.authorSteve Qian
dc.contributor.authorDouglas A. Simonetto
dc.contributor.authorJoseph C. Ahn
dc.contributor.authorSeth Buryska
dc.contributor.authorWinston Dunn
dc.contributor.authorHeer Mehta
dc.contributor.authorRohit Agrawal
dc.contributor.authorJoaquín Cabezas
dc.contributor.authorInés García-Carrera
dc.contributor.authorBerta Cuyàs
dc.contributor.authorMaria Poca
dc.contributor.authorGerman Soriano
dc.contributor.authorShiv K. Sarin
dc.contributor.authorRakhi Maiwall
dc.contributor.authorPrasun K. Jalal
dc.contributor.authorSaba Abdulsada
dc.contributor.authorFátima Higuera-de-la-Tijera
dc.contributor.authorAnand V. Kulkarni
dc.contributor.authorP. Nagaraja Rao
dc.contributor.authorPatricia Guerra Salazar
dc.contributor.authorLubomir Skladaný
dc.contributor.authorNatália Bystrianska
dc.contributor.authorAna Clemente-Sanchez
dc.contributor.authorClara Villaseca-Gómez
dc.contributor.authorTehseen Haider
dc.contributor.authorKristina R. Chacko
dc.contributor.authorGustavo A. Romero
dc.contributor.authorFlorencia D. Pollarsky
dc.contributor.authorJuan Carlos Restrepo
dc.contributor.authorSusana Castro-Sanchez
dc.contributor.authorLuis G. Toro
dc.contributor.authorPamela Yaquich
dc.contributor.authorManuel Mendizabal
dc.contributor.authorMaria Laura Garrido
dc.contributor.authorSebastián Marciano
dc.contributor.authorMelisa Dirchwolf
dc.contributor.authorVictor Vargas
dc.contributor.authorCésar Jiménez
dc.contributor.authorAlexandre Louvet
dc.contributor.authorGuadalupe García-Tsao
dc.contributor.authorJuan Pablo Roblero
dc.contributor.authorJuan G. Abraldes
dc.contributor.authorVijay H. Shah
dc.contributor.authorPatrick S. Kamath
dc.contributor.authorMarco Arrese
dc.contributor.authorAshwani K. Singal
dc.contributor.authorRamon Bataller
dc.contributor.authorJuan Pablo Arab
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.rightsAttribution-NonCommercial-NoDerivatives 4.0 Internationalen
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/4.0/
dc.sourceJournal of Hepatology
dc.titleMELD 3.0 adequately predicts mortality and renal replacement therapy requirements in patients with alcohol-associated hepatitis
dc.typeArticle
oaire.citation.volume5
organization.identifier.rorUniversidad de Antofagasta
uantof.identificator.departmentDepartamento Ciencias Médicas
uantof.identificator.facultyFacultad de Medicina y Odontología
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