Assessment of the Model for End-stage Liver Disease (MELD) Score in Predicting Prognosis of Patients with Alcoholic Hepatitis

Abstract

Background: Traditionally, Maddrey discriminant function (DF) score has been used for stratifying the prognosis of alcoholic hepatitis. Recently, the Model for end-stage liver disease (MELD) score has been applied to alcoholic hepatitis and some investigators consider MELD score as a better prognostic indicator. Another new prognostic approach, Lille model has been also suggested to accurately identify patients at high risk of death. Therefore, this prospective study was aimed to compare MELD, DF, Child-Turcotte-Pugh (CTP) scores and Lille model for predicting the short-term mortality in Indian patients with alcoholic hepatitis. Methods: We calculated the DF, CTP, MELD and Lille scores in patients hospitalized with alcoholic hepatitis & evaluated if the scores predicted in-hospital mortality. Results: A total of 104 patients were enrolled and thirty-two (30.7%) patients died during the hospitalization (2-30 days). Admission DF score (OR 1.1, P < 0.04), CTP (OR 2, P < 0.05) MELD score (OR 2.2, P < 0.005) and first week MELD score (OR 1.1, P < 0.05) were independently associated with in-hospital mortality. The area under the receiver-operating curve (AUROC) for the admission and day 7 MELD score was significantly higher than CTP score and was comparable to DF score and Lille model ( . The MELD score >14 at admission and >12 at day 7 had high sensitivity and specificity in predicting short-term mortality (96%, 89% and 95%, 98% respectively). The cutoff of 0.45 for the Lille model was able to identify 79% of the observed deaths, whereas DF score $32 for DF were able to identify 85%. Conclusion: MELD score, as a predictive model for assessment of short-term mortality in alcoholic hepatitis is better than CTP and comparable to DF and Lille model. ( J CLIN EXP HEPATOL 2014;4:19-24)

The MELD Score Is Superior to the Maddrey Discriminant Function Score to Predict Short-Term Mortality in Alcohol-Associated Hepatitis: A Global Study

“…Indeed, mDF is one of the most commonly used scores to determine The American Journal of GASTROENTEROLOGY prognosis and determine the need for steroids in clinical trials (26). In recent studies, mDF has shown a lower accuracy for mortality prediction than the other prognostic scores (6,27,28). This is probably because mDF does not include renal function, an important prognostic factor in AH (29).…”

Incidence and Progression of Alcohol-Associated Liver Disease After Medical Therapy for Alcohol Use Disorder

“…2 The most aggressive form of ALD is severe alcohol-associated hepatitis, which has a 30% 3-month mortality rate. 3,4 A surge in the incidence of ALD is expected with the COVID-19-related increase in alcohol use. [5][6][7] It is, therefore, critical to prevent the development of ALD to limit the morbidity and mortality associated with excessive alcohol use.…”

“…Alcohol-associated liver disease represents a wide spectrum, ranging from the relatively benign hepatic steatosis to cirrhosis and hepatocellular carcinoma . The most aggressive form of ALD is severe alcohol-associated hepatitis, which has a 30% 3-month mortality rate . A surge in the incidence of ALD is expected with the COVID-19–related increase in alcohol use .…”

Pharmacologic Treatment of Alcoholic Hepatitis: Examining Outcomes Based on Disease Severity Stratification

“…3,16 Although promising data are starting to emerge utilizing MELD as an alternative method to stratify AH patients for treatment, the majority of the small studies find it comparable to MDF. [16][17][18] When stratifying patients in our study by MELD score, we found no difference in mortality outcomes when utilizing a cutoff of 18. Further studies are needed to assess the true utility of the MELD score in AH patients and its ability to yield a greater survival benefit when compared to MDF.…”

“…14 Goyal and colleagues compared these two stratification methods in a small population and found that MELD score is as effective as MDF in predicting 30-day mortality and found that MELD greater than 14 at admission and greater than 12 at day 7 were strongly correlated with short-term mortality. 15 Dunn and colleagues found that MELD was also comparable to MDF in predicting 30-day and 90-day mortalities, with MELD being the only independent predictor of 90-day mortality. 14 However, the authors concluded that AH patients with a MELD greater than 21 should be considered for pharmacologic therapy, as this score maintained a greater sensitivity and specificity at predicting 90-day mortality.…”