MELD score is a better prognostic model than Child-Turcotte-Pugh score or Discriminant Function score in patients with alcoholic hepatitis

Srikureja, Wichit; Kyulo, Namgyal L.; Runyon, Bruce A.; Hu, Ke–Qin

doi:10.1016/j.jhep.2004.12.022

Cited by 210 publications

(173 citation statements)

References 16 publications

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“…MELD was similar to DFI for predicting 30 day mortality in 3 studies (c-statistic of 0.82, 0.73, and 0.89 for MELD >11, 21, and 18 vs. 0.86, 0.69, and 0.81 respectively for DFI >32 [71][72][73] ); superior to DFI in 2 studies in predicting 30 day mortality (0.83 for MELD >22 vs. 0.74 for DFI >41 74 or occurrence of complications of liver disease in one study 75 ); and inferior to DFI in one study. 76 Three studies comparing MELD and CTP showed 2 scores to be similar for mortality during the hospital stay 72 or at 3 and 6 months 6 while in the third study, CTP but not MELD was predictor of 90 day mortality. 76 Apart from other limitations of MELD score, specific issue pertaining to AH is variation in MELD score cut off to accurately predict mortality ranging from 11 to 22 in different studies.…”

Section: Alcoholic Hepatitismentioning

confidence: 75%

Model for End-stage Liver Disease

Singal

Kamath

2013

Journal of Clinical and Experimental Hepatology

132

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Section: Alcoholic Hepatitismentioning

confidence: 75%

Model for End-stage Liver Disease

Singal

Kamath

2013

Journal of Clinical and Experimental Hepatology

132

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“…We hypothesized that the AUROC of MELD and Maddrey scores would not be significantly different, according to two previous studies comparing both scores. 16,18 With an ␣ risk of 0.05 and a ␤ risk of 0.2, a prevalence of death at 0.4, and a bilateral test, the sample size was calculated for the following hypotheses of AUROC curves: 0.85 for the Lille model and 0.7 for the Maddrey or MELD. Thus, the sample size of the validating cohort was calculated to be at least 100 patients.…”

Section: Discussionmentioning

confidence: 99%

“…However, we lack evidence supporting the higher efficacy of new models such as MELD and Glasgow scores compared with the DF. [16][17][18] In the particular setting of …”

mentioning

confidence: 99%

“…However, we lack evidence supporting the higher efficacy of new models such as MELD and Glasgow scores compared with the DF. [16][17][18] In the particular setting of patients treated by corticosteroids, new specific models could pose a challenge to clinical practitioners by inciting them to consider all available options in targeted patients after a short period of evaluation. 15,19,20 The aims of the current study on a large cohort of patients with severe AH prospectively treated with corticosteroids were: (1) to generate a specific prognostic model, the socalled Lille model, enabling clinicians to identify subjects early on who are unlikely to survive; and (2) to propose new management based on this specific model.…”

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confidence: 99%

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The Lille model: A new tool for therapeutic strategy in patients with severe alcoholic hepatitis treated with steroids

et al. 2007

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Early identification of patients with severe (discriminant function > 32) alcoholic hepatitis (AH) not responding to corticosteroids is crucial. We generated a specific prognostic model (Lille model) to identify candidates early on for alternative therapies. Three hundred twenty patients with AH prospectively treated by corticosteroids were included in the development cohort and 118 in its validation. Baseline data and a change in bilirubin at day 7 were tested. The model was generated by logistic regression. The model combining six reproducible variables (age, renal insufficiency, albumin, prothrombin time, bilirubin, and evolution of bilirubin at day 7) was highly predictive of death at 6 months (P < 0.000001). The area under the receiver operating characteristic (AUROC) curve of the Lille model was 0.89 ؎ 0.02, higher than the Child-Pugh (0.62 ؎ 0.04, P < 0.00001) or Maddrey scores (0.66 ؎ 0.04, P < 0.00001). In the validation cohort, its AUROC was 0.85 ؎ 0.04, still higher than the other models, including MELD (0.72 ؎ 0.05, P ‫؍‬ 0.01) and Glasgow scores (0.67 ؎ 0.05, P ‫؍‬ 0.0008). Patients above the ideal cutoff of 0.45 showed a marked decrease in 6-month survival as compared with others: 25% ؎ 3.8% versus 85% ؎ 2.5%, P < 0.0001. This cutoff was able to identify approximately 75% of the observed deaths. Conclusion: In the largest cohort to date of patients with severe AH, we demonstrate that the term "nonresponder" can now be extended to patients with a Lille score above 0.45, which corresponds to 40% of cases. Early identification of subjects with substantial risk of death according to the Lille model will improve management of patients suffering from severe AH and will aid in the design of future studies for alternative therapies. (HEPATOLOGY 2007;45:1348-1354 T he treatment of severe forms of alcoholic hepatitis (AH) constitutes a major challenge in management of severe alcoholic liver disease. Before the era of the Maddrey function (DF), 1,2 clinicians faced substantial difficulties in identifying subgroups of patients with high risk of death over a short term; as a consequence, survival of untreated patients enrolled in randomized controlled trials (RCTs) ranged from 0 to 81%. 3 Since the use of DF (DF Ն 32) in several RCTs, 1,4-6 spontaneous 2-month survival has been approximately 50%. The DF clearly demonstrates the tremendous progress provided by elaborating specific prognostic functions for AH. The advantage of accurate models has been confirmed by the growing importance of the MELD score in the selection of candidates for liver transplantation. [7][8][9] In patients with DF Ն 32, several RCTs and a recent meta-analysis showed that corticosteroids improve shortterm survival. 1,5,10-14 However, novel strategies or molecules are required, in light of the fact that approximately 40% of patients die at 6 months. 15 Therefore, improvement in the prediction of mortality in severe AH is warranted. However, we lack evidence supporting the higher efficacy of new models such as MELD and Glasgow scores compa...

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“…MELD has also been shown to have utility in predicting outcome in patients suffering from acute liver failure, alcoholic hepatitis, and in patients with chronic liver disease undergoing surgery or experiencing traumatic injury [14][15][16][17][18]. To date, however, it has not been shown to reliably predict post-liver transplant mortality.…”

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confidence: 99%

MELD—good for many, not as good for others … at least for now

Schiano

2012

Hepatol Int

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MELD score is a better prognostic model than Child-Turcotte-Pugh score or Discriminant Function score in patients with alcoholic hepatitis

Cited by 210 publications

References 16 publications

Model for End-stage Liver Disease

Model for End-stage Liver Disease

The Lille model: A new tool for therapeutic strategy in patients with severe alcoholic hepatitis treated with steroids

MELD—good for many, not as good for others … at least for now

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