MELD 3.0 adequately predicts mortality and renal replacement therapy requirements in patients with alcohol-associated hepatitis.

Autor:	Díaz LA; Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile., Fuentes-López E; Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile., Ayares G; Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile., Idalsoaga F; Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile., Arnold J; Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile., Valverde MA; Servicio Medicina Interna, Hospital El Pino, Santiago, Chile., Perez D; Servicio Medicina Interna, Hospital El Pino, Santiago, Chile., Gómez J; Servicio Medicina Interna, Hospital El Pino, Santiago, Chile., Escarate R; Servicio Medicina Interna, Hospital El Pino, Santiago, Chile., Villalón A; Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.; Departamento de Ciencias Médicas, Facultad de Medicina y Odontología, Universidad de Antofagasta, Antofagasta, Chile., Ramírez CA; Department of Anesthesia & Perioperative Medicine, Western University, London, ON, Canada., Hernandez-Tejero M; Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.; Liver Unit, Hospital Clinic, Barcelona, Spain., Zhang W; Division of Gastroenterology and Hepatology, University of Florida, Gainesville, FL, USA.; Gastroenterology Unit, Massachusetts General Hospital, Boston, MA, USA., Qian S; Division of Gastroenterology and Hepatology, University of Florida, Gainesville, FL, USA., Simonetto DA; Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA., Ahn JC; Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA., Buryska S; Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA., Dunn W; University of Kansas Medical Center, KS, USA., Mehta H; University of Kansas Medical Center, KS, USA., Agrawal R; Division of Gastroenterology and Hepatology, University of Illinois, Chicago, IL, USA., Cabezas J; Gastroenterology and Hepatology Department. University Hospital Marqués de Valdecilla, Santander, Spain.; Research Institute Valdecilla (IDIVAL), Santander, Spain., García-Carrera I; Gastroenterology and Hepatology Department. University Hospital Marqués de Valdecilla, Santander, Spain.; Research Institute Valdecilla (IDIVAL), Santander, Spain., Cuyàs B; Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Institut de Recerca Hospital de Sant Pau-IIB Sant Pau, Universitat Autònoma de Barcelona, CIBERehd, Barcelona, Spain., Poca M; Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Institut de Recerca Hospital de Sant Pau-IIB Sant Pau, Universitat Autònoma de Barcelona, CIBERehd, Barcelona, Spain., Soriano G; Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Institut de Recerca Hospital de Sant Pau-IIB Sant Pau, Universitat Autònoma de Barcelona, CIBERehd, Barcelona, Spain., Sarin SK; Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India., Maiwall R; Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India., Jalal PK; Department of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, TX, USA., Abdulsada S; Department of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, TX, USA., Higuera-de-la-Tijera F; Servicio de Gastroenterología, Hospital General de México 'Dr. Eduardo Liceaga', Facultad de Medicina, Universidad Nacional Autónoma de México, México City, Mexico., Kulkarni AV; Department of Hepatology, Asian Institute of Gastroenterology, Hyderabad, India., Rao PN; Department of Hepatology, Asian Institute of Gastroenterology, Hyderabad, India., Salazar PG; Instituto de Gastroenterología Boliviano-Japonés, Cochabamba, Bolivia., Skladaný L; Division of Hepatology, Gastroenterology and Liver Transplantation, Department of Internal Medicine II, Slovak Medical University, F.D. Roosevelt University Hospital, Banska Bystrica, Slovak Republic., Bystrianska N; Division of Hepatology, Gastroenterology and Liver Transplantation, Department of Internal Medicine II, Slovak Medical University, F.D. Roosevelt University Hospital, Banska Bystrica, Slovak Republic., Clemente-Sanchez A; Liver Unit, Department of Digestive Diseases Hospital General Universitario Gregorio Marañón Madrid, Madrid, Spain.; CIBERehd Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas Madrid, Madrid, Spain., Villaseca-Gómez C; Liver Unit, Department of Digestive Diseases Hospital General Universitario Gregorio Marañón Madrid, Madrid, Spain.; CIBERehd Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas Madrid, Madrid, Spain., Haider T; Division of Gastroenterology and Hepatology, Montefiore Medical Center, Bronx, NY, USA., Chacko KR; Division of Gastroenterology and Hepatology, Montefiore Medical Center, Bronx, NY, USA., Romero GA; Sección Hepatología, Hospital de Gastroenterología Dr. Carlos Bonorino Udaondo, Buenos Aires, Argentina., Pollarsky FD; Sección Hepatología, Hospital de Gastroenterología Dr. Carlos Bonorino Udaondo, Buenos Aires, Argentina., Restrepo JC; Unidad de Hepatología del Hospital Pablo Tobon Uribe, Grupo de Gastrohepatología de la Universidad de Antioquia, Medellín, Colombia., Castro-Sanchez S; Unidad de Hepatología del Hospital Pablo Tobon Uribe, Grupo de Gastrohepatología de la Universidad de Antioquia, Medellín, Colombia., Toro LG; Hepatology and Liver Transplant Unit, Hospitales de San Vicente Fundación de Medellín y Rionegro, Medellín, Colombia., Yaquich P; Departamento de Gastroenterología, Hospital San Juan de Dios, Santiago, Chile., Mendizabal M; Hepatology and Liver Transplant Unit, Hospital Universitario Austral, Buenos Aires, Argentina., Garrido ML; Hospital Central Dr. Ramon Carrillo, San Luis, Argentina., Marciano S; Liver Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina., Dirchwolf M; Unidad de Hígado, Hospital Privado de Rosario, Rosario, Argentina., Vargas V; Liver Unit, Hospital Vall d'Hebron, Vall d'Hebron Research Institute (VHIR), Universitat Autonoma Barcelona, CIBEREHD, Barcelona, Spain., Jiménez C; Liver Unit, Hospital Vall d'Hebron, Vall d'Hebron Research Institute (VHIR), Universitat Autonoma Barcelona, CIBEREHD, Barcelona, Spain., Louvet A; Hôpital Claude Huriez, Services des Maladies de l'Appareil Digestif, CHRU Lille, and Unité INSERM 995, Lille, France., García-Tsao G; Section of Digestive Diseases, Yale University School of Medicine/VA-CT Healthcare System, New Haven/West Haven, CT, USA., Roblero JP; Sección Gastroenterología, Hospital Clínico Universidad de Chile, Escuela de Medicina Universidad de Chile, Santiago, Chile., Abraldes JG; Division of Gastroenterology, Liver Unit, University of Alberta, Edmonton, AB, Canada., Shah VH; Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA., Kamath PS; Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA., Arrese M; Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile., Singal AK; Department of Medicine, University of South Dakota Sanford School of Medicine and Transplant Hepatology, Avera Transplant Institute, Sioux Falls, SD, USA., Bataller R; Liver Unit, Hospital Clinic, Barcelona, Spain., Arab JP; Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.; Division of Gastroenterology, Department of Medicine, Schulich School of Medicine, Western University & London Health Sciences Centre, London, ONT, Canada.; Department of Epidemiology and Biostatistics, Schulich School of Medicine, Western University, London, ONT, Canada.
Jazyk:	angličtina
Zdroj:	JHEP reports : innovation in hepatology [JHEP Rep] 2023 Mar 15; Vol. 5 (8), pp. 100727. Date of Electronic Publication: 2023 Mar 15 (Print Publication: 2023).
DOI:	10.1016/j.jhepr.2023.100727
Abstrakt:	Background & Aims: Model for End-Stage Liver Disease (MELD) score better predicts mortality in alcohol-associated hepatitis (AH) but could underestimate severity in women and malnourished patients. Using a global cohort, we assessed the ability of the MELD 3.0 score to predict short-term mortality in AH. Methods: This was a retrospective cohort study of patients admitted to hospital with AH from 2009 to 2019. The main outcome was all-cause 30-day mortality. We compared the AUC using DeLong's method and also performed a time-dependent AUC with competing risks analysis. Results: A total of 2,124 patients were included from 28 centres from 10 countries on three continents (median age 47.2 ± 11.2 years, 29.9% women, 71.3% with underlying cirrhosis). The median MELD 3.0 score at admission was 25 (20-33), with an estimated survival of 73.7% at 30 days. The MELD 3.0 score had a better performance in predicting 30-day mortality (AUC:0.761, 95%CI:0.732-0.791) compared with MELD sodium (MELD-Na; AUC: 0.744, 95% CI: 0.713-0.775; p  = 0.042) and Maddrey's discriminant function (mDF) (AUC: 0.724, 95% CI: 0.691-0.757; p  = 0.013). However, MELD 3.0 did not perform better than traditional MELD (AUC: 0.753, 95% CI: 0.723-0.783; p  = 0.300) and Age-Bilirubin-International Normalised Ratio-Creatinine (ABIC) (AUC:0.757, 95% CI: 0.727-0.788; p  = 0.765). These results were consistent in competing-risk analysis, where MELD 3.0 (AUC: 0.757, 95% CI: 0.724-0.790) predicted better 30-day mortality compared with MELD-Na (AUC: 0.739, 95% CI: 0.708-0.770; p  = 0.028) and mDF (AUC:0.717, 95% CI: 0.687-0.748; p  = 0.042). The MELD 3.0 score was significantly better in predicting renal replacement therapy requirements during admission compared with the other scores (AUC: 0.844, 95% CI: 0.805-0.883). Conclusions: MELD 3.0 demonstrated better performance compared with MELD-Na and mDF in predicting 30-day and 90-day mortality, and was the best predictor of renal replacement therapy requirements during admission for AH. However, further prospective studies are needed to validate its extensive use in AH. Impact and Implications: Severe AH has high short-term mortality. The establishment of treatments and liver transplantation depends on mortality prediction. We evaluated the performance of the new MELD 3.0 score to predict short-term mortality in AH in a large global cohort. MELD 3.0 performed better in predicting 30- and 90-day mortality compared with MELD-Na and mDF, but was similar to MELD and ABIC scores. MELD 3.0 was the best predictor of renal replacement therapy requirements. Thus, further prospective studies are needed to support the wide use of MELD 3.0 in AH. (© 2023 The Author(s).)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu