Model for End‐Stage Liver Disease‐Lactate and Prediction of Inpatient Mortality in Patients With Chronic Liver Disease

Abstract

Background and Aims Compared to other chronic diseases, patients with chronic liver disease (CLD) have significantly higher inpatient mortality; accurate models to predict inpatient mortality are lacking. Serum lactate (LA) may be elevated in patients with CLD due to both tissue hypoperfusion as well as decreased LA clearance. We hypothesized that a parsimonious model consisting of Model for End‐Stage Liver Disease (MELD) and LA at admission may predict inpatient mortality in patients with CLD. Approach and Results We examined all patients with CLD in two large and diverse health care systems in Texas (North Texas [NTX] and Central Texas [CTX]) between 2010 and 2015. We developed (n = 3,588) and validated (n = 1,804) a model containing MELD and LA measured at the time of hospitalization. We further validated the model in a second cohort of 14 tertiary care hepatology centers that prospectively enrolled nonelective hospitalized patients with cirrhosis (n = 726). MELD‐LA was an excellent predictor of inpatient mortality in development (concordance statistic [C‐statistic] = 0.81, 95% confidence interval [CI] 0.79‐0.82) and both validation cohorts (CTX cohort, C‐statistic = 0.85, 95% CI 0.78‐0.87; multicenter cohort C‐statistic = 0.82, 95% CI 0.74‐0.88). MELD‐LA performed especially well in patients with specific cirrhosis diagnoses (C‐statistic = 0.84, 95% CI 0.81‐0.86) or sepsis (C‐statistic = 0.80, 95% CI 0.78‐0.82). For MELD score 25, inpatient mortality rates were 11.2% (LA = 1 mmol/L), 19.4% (LA = 3 mmol/L), 34.3% (LA = 5 mmol/L), and >50% (LA > 8 mmol/L). A linear increase (P < 0.01) was seen in MELD‐LA and increasing number of organ failures. Overall, use of MELD‐LA improved the risk prediction in 23.5% of patients compared to MELD alone. Conclusions MELD‐LA (bswh.md/meldla) is an early and objective predictor of inpatient mortality and may serve as a model for risk assessment and guide therapeutic options.

Comparison of mortality risk in patients with cirrhosis and COVID-19 compared with patients with cirrhosis alone and COVID-19 alone: multicentre matched cohort

“…A higher serum lactate in those with cirrhosis+COVID-19 could signal a greater anaerobic milieu, which has already been shown to be associated with high mortality in cirrhosis. 17 Therefore, a lower hepatic reserve and worse CCI could predispose to this higher death rate. Indeed, the only significant predictor of mortality was the CCI.…”

Prognostic Value of Acute-On-Chronic Liver Failure (ACLF) Score in Critically Ill Patients with Cirrhosis and ACLF

“…The liver accounts for 70% of lactate clearance in the human body [ 25 ], and several studies have focused on the importance of lactate and lactate clearance in critically ill patients with cirrhosis and in ACLF patients [ 7 , 8 , 26 , 27 ]. Some studies proved that using lactate level could improve the accuracy of the traditional model, and constructed improved models like CLIF-C ACLFs Lact [ 8 ] and MELD-LA [ 9 ]. Lactate level (HR: 1.111, 95% CI: 1.081,1.142, p<0.001) was also verified as an independent risk factor for 28-day mortality in our study.…”

“…Some studies have found that lactate levels have good predictive value in critically ill patients with cirrhosis [ 7 – 9 ], and several traditional models were improved by adding lactate, such as CLIF-C ACLFs Lact [ 8 ]. However, most of the models are too complex to use at bedside.…”

Development, Validation, and Evaluation of a Simple Machine Learning Model to Predict Cirrhosis Mortality

“…Other prognostic scores in cirrhosis are mostly applicable in restricted settings, such as scores predicting short-term risk of dying during or after hospitalization. 8 , 9 None of these scores account for a wide range of clinical and psychosocial factors that are likely to be associated with mortality in cirrhosis. Machine learning techniques have been used to help fill these gaps for cirrhosis but have not seen widespread use.…”