Validation of MELD 3.0 in patients with alcoholic liver cirrhosis using prospective KACLiF cohort

• Published in: Journal of gastroenterology and hepatology 2024-09, Vol.39 (9), p.1932-1938
• Main Authors: Lim, Jihye, Kim, Jung Hee, Kim, Sung‐Eun, Han, Seul Ki, Kim, Tae Hyung, Yim, Hyung Joon, Jung, Young Kul, Song, Do Seon, Yoon, Eileen L., Kim, Hee Yeon, Kang, Seong Hee, Chang, Young, Yoo, Jeong‐Ju, Lee, Sung Won, Park, Jung Gil, Park, Ji Won, Jeong, Soung Won, Suk, Ki Tae, Kim, Moon Young, Kim, Sang Gyune, Kim, Won, Jang, Jae Young, Yang, Jin Mo, Kim, Dong Joon
• Format: Article
• Language: English
• Subjects: acute; Adult; alcoholic; Aspartate transaminase; Bilirubin; Cirrhosis; Cohort Studies; Creatinine; End Stage Liver Disease - blood; End Stage Liver Disease - diagnosis; End Stage Liver Disease - mortality; end‐stage liver disease; Female; Hepatitis; Humans; Liver cirrhosis; Liver Cirrhosis, Alcoholic - complications; Liver Cirrhosis, Alcoholic - diagnosis; Liver diseases; liver failure; Liver Transplantation; Liver transplants; Male; Middle Aged; Predictive Value of Tests; Prognosis; Prospective Studies; Prothrombin; Republic of Korea - epidemiology; ROC Curve; Severity of Illness Index; Statistical analysis; Time Factors; Transaminase
• ISSN: 0815-9319; 1440-1746; 1440-1746
• DOI: 10.1111/jgh.16591

Background and Aim The Model for End‐Stage Liver Disease (MELD) is a reliable prognostic tool for short‐term outcome prediction in patients with end‐stage liver disease. MELD 3.0 was introduced to enhance the predictive accuracy. This study assessed the performance of MELD 3.0, in comparison to MELD and MELD‐Na, in patients with alcoholic liver cirrhosis. Methods This multicenter prospective cohort study comprised patients with alcoholic cirrhosis admitted for acute deterioration of liver function in the Republic of Korea between 2015 and 2019. This study compared the predictive abilities of MELD, MELD‐Na, and MELD 3.0, for 30‐day and 90‐day outcomes, specifically death or liver transplantation, and explored the factors influencing these outcomes. Results A total of 1096 patients were included in the study, with a mean age of 53.3 ± 10.4 years, and 82.0% were male. The mean scores for MELD, MELD‐Na, and MELD 3.0 at the time of admission were 18.7 ± 7.2, 20.6 ± 7.7, and 21.0 ± 7.8, respectively. At 30 and 90 days, 7.2% and 14.1% of patients experienced mortality or liver transplantation. The areas under the receiver operating characteristic curves for MELD, MELD‐Na, and MELD 3.0 at 30 days were 0.823, 0.820, and 0.828; and at 90 days were 0.765, 0.772, and 0.776, respectively. Factors associated with the 90‐day outcome included concomitant chronic viral hepatitis, prolonged prothrombin time, elevated levels of aspartate transaminase, bilirubin, and creatinine, and low albumin levels. Conclusion MELD 3.0 demonstrated improved performance compared to previous models, although the differences were not statistically significant.