MELD-Lactate Predicts Poor Outcome in Variceal Bleeding in Cirrhosis.

Autor: Horvatits T; I. Department of Medicine, Gastroenterology and Hepatology, University Medical Center Hamburg-Eppendorf, Martinistr. 42, 20246, Hamburg, Germany. t.horvatits@uke.de., Mahmud N; Division of Gastroenterology and Hepatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA.; Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA., Serper M; Division of Gastroenterology and Hepatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA.; Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA., Seiz O; I. Department of Medicine, Gastroenterology and Hepatology, University Medical Center Hamburg-Eppendorf, Martinistr. 42, 20246, Hamburg, Germany., Reher D; I. Department of Medicine, Gastroenterology and Hepatology, University Medical Center Hamburg-Eppendorf, Martinistr. 42, 20246, Hamburg, Germany., Drolz A; I. Department of Medicine, Gastroenterology and Hepatology, University Medical Center Hamburg-Eppendorf, Martinistr. 42, 20246, Hamburg, Germany., Sarnast N; Baylor Scott and White, Baylor University Medical Center, Dallas, TX, USA., Gu W; Department of Internal Medicine I, University of Frankfurt, Frankfurt, Germany., Erasmus HP; Department of Internal Medicine I, University of Frankfurt, Frankfurt, Germany., Allo G; Department of Gastroenterology and Hepatology, University Hospital Cologne, Cologne, Germany., Ferstl P; Department of Internal Medicine I, University of Frankfurt, Frankfurt, Germany., Wittmann S; I. Department of Medicine, Gastroenterology and Hepatology, University Medical Center Hamburg-Eppendorf, Martinistr. 42, 20246, Hamburg, Germany., Piecha F; I. Department of Medicine, Gastroenterology and Hepatology, University Medical Center Hamburg-Eppendorf, Martinistr. 42, 20246, Hamburg, Germany., Groth S; Department of Interdisciplinary Endoscopy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany., Zeuzem S; Department of Internal Medicine I, University of Frankfurt, Frankfurt, Germany., Schramm C; Department of Gastroenterology and Hepatology, University Hospital Cologne, Cologne, Germany., Huber S; I. Department of Medicine, Gastroenterology and Hepatology, University Medical Center Hamburg-Eppendorf, Martinistr. 42, 20246, Hamburg, Germany., Rösch T; Department of Interdisciplinary Endoscopy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany., Lohse AW; I. Department of Medicine, Gastroenterology and Hepatology, University Medical Center Hamburg-Eppendorf, Martinistr. 42, 20246, Hamburg, Germany., Trebicka J; Department of Internal Medicine I, University of Frankfurt, Frankfurt, Germany., Ogola G; Baylor Scott and White, Baylor University Medical Center, Dallas, TX, USA., Asrani SK; Baylor Scott and White, Baylor University Medical Center, Dallas, TX, USA., Kluwe J; I. Department of Medicine, Gastroenterology and Hepatology, University Medical Center Hamburg-Eppendorf, Martinistr. 42, 20246, Hamburg, Germany.
Jazyk: angličtina
Zdroj: Digestive diseases and sciences [Dig Dis Sci] 2023 Mar; Vol. 68 (3), pp. 1042-1050. Date of Electronic Publication: 2022 Nov 14.
DOI: 10.1007/s10620-022-07744-w
Abstrakt: Background: Predictors of poor outcome associated with variceal bleeding remain suboptimal. In patients with cirrhosis, serum lactate combined with Model for End-Stage Liver Disease (MELD-LA) improved prediction across heterogeneous populations. However, prognostic properties have not yet been assessed in the context of variceal bleeding.
Aims: We aimed to evaluate the predictive performance of MELD-LA compared to MELD, lactate, and nadir hemoglobin in cirrhosis patients with variceal bleeding.
Methods: In this multicenter study, we identified 472 patients with variceal bleeding from a German primary cohort (University Hospitals Hamburg/Frankfurt/Cologne), and two independent external validation cohorts [Veterans Affairs (VA), Baylor University]. Discrimination for 30-day mortality was analyzed and scores were compared. MELD-LA was evaluated separately in validation cohorts to ensure consistency of findings.
Results: In contrast to nadir hemoglobin, MELD and peak-lactate at time of bleeding were significantly higher in 30-day non-survivors in the primary cohort (p = 0.708; p < 0.001). MELD-LA had excellent discrimination for 30-day mortality (AUROC 0.82, 95% CI 0.76-0.88), better than MELD and peak-lactate (AUROC 0.78, 95% CI 0.71-0.84; AUROC 0.73, 95% CI 0.66-0.81). MELD-LA predicted 30-day mortality independently of age, sex, severity of liver disease and vasopressor support (HR 1.29 per 1-point-increase of MELD-LA; 95% CI 1.19-1.41; p < 0.001). Similarly, MELD-LA demonstrated excellent discrimination for 30-day mortality in the VA (AUROC = 0.86, 95% CI 0.79-0.93) and Baylor cohort (AUROC = 0.85, 95% CI 0.74-0.95).
Conclusions: MELD-LA significantly improves discrimination of short-term mortality associated with variceal bleeding, compared to MELD, peak-lactate and nadir hemoglobin. Thus, MELD-LA might represent a useful and objective marker for risk assessment and therapeutic intervention in patients with variceal bleeding.
(© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
Databáze: MEDLINE
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