Gene signature‐MELD score and alcohol relapse determine long‐term prognosis of patients with severe alcoholic hepatitis

Abstract

Background The gene‐signature‐model for end stage liver disease (gs‐MELD) score has been shown to be a strong predictor of 6‐month survival in severe alcoholic hepatitis (AH). Currently, only a few studies have evaluated the long‐term prognosis of patients with severe AH. Aim To assess the prognostic value of the gs‐MELD score at 5 years in patients with severe AH. Methods Forty‐eight consecutive patients with AH (25 males, median age 52 years [95% IC: 48‐56]) were included. Results The median gs‐MELD score was 2.6 (95% CI: 2.2‐3.0). According to the gs‐MELD score, 22 patients (46%) were considered to have a poor prognosis. During a median follow‐up of 29 months (95% CI: 4‐43), 19 patients (40%) were abstinent and 24 patients (50%) died. At 5 years, rates of survival were 61% (95% CI: 41‐81) and 26% (95% CI: 11‐55) in patients with low and high gs‐MELD scores (P = .001), and 81% (95% CI: 58‐96) and 22% (95% CI: 10‐47) in abstainers and in consumers (P < .001) respectively. In multivariable competing risk regression modelling, gs‐MELD score (subdistribution hazard ratio: 5.78, 95% CI: 2.17‐15.38, P < .001) and recurrent alcohol consumption (subdistribution hazard ratio: 12.18, 95% CI: 3.16‐46.95, P < .001) were independently associated with 5‐year mortality. Conclusions Both gs‐MELD score and alcohol consumption drive AH long‐term prognosis. The gs‐MELD score may guide the development of molecularly targeted therapies in AH.

Long-term outcomes in patients with decompensated alcohol-related liver disease, steatohepatitis and Maddrey's discriminant function <32

“…[26][27][28][29] Moreover, while scores of liver disease severity such as the MELD and Lille scores are prognostic of short-term mortality in patients with severe AH, alcohol relapse is a key factor of long-term mortality in this population. [7][8][9] The definition of abstinence varies in different studies. We defined abstinence as complete abstinence from alcohol within the year after liver biopsy without any relapse thereafter.…”

“…[3][4][5][6] It has been previously shown that severity scores, including the model for end-stage liver disease (MELD) and the Lille score, predict short-term mortality in patients with severe AH treated with corticosteroids and that alcohol abstinence is the main predictor of long-term survival. [7][8][9] Patients with AH and an mDF <32 have less than a 10% risk of 1-month mortality 3 and are typically not considered for specific therapy. However, the definition of AH severity is based on old studies and the evolution of non-severe forms of AH is still uncertain.…”

Predicting long‐term prognosis in severe alcoholic hepatitis

“…9 Trépo and colleagues have taken up this challenge and have recently adopted the novel approach of determining outcomes in patients with severe AH utilizing transcriptome profiling. 10 In this issue of the journal the same authors, 11 having shown that the gs-MELD scoring system accurately predicts 90 and 180 day survival in patients with severe AH, now report data on the predictive validity of the score for determining long-term survival in the same population. This post-hoc analysis was undertaken using follow-up data from the 48 patients with severe AH who comprised the validation cohort in the index publication.…”

“…The work undertaken by this group 10,11 is an excellent example of how combining individual genetic expression data and clinically available routine variables can be used to build a prognostic score. A particular strength of the gs-MELD scoring system is that the prognostic information is available sufficiently early to be used to guide management and avoid use of medication which may cause adverse effects.…”

“…A particular strength of the gs-MELD scoring system is that the prognostic information is available sufficiently early to be used to guide management and avoid use of medication which may cause adverse effects. The group 10,11 have contributed significantly and with remarkable innovation to improving the stratification of patients with severe AH and to afford focused care for those at highest risk from this life-threatening condition. Further independent validation is now warranted since the question of whether or not the gs-MELD predicts longer term outcomes is moot.…”