The MELD Score Is Superior to the Maddrey Discriminant Function Score to Predict Short-Term Mortality in Alcohol-Associated Hepatitis: A Global Study
Por:
Morales-Arráez D., Ventura-Cots M., Altamirano J., Abraldes J.G., Cruz-Lemini M., Thursz M.R., Atkinson S.R., Sarin S.K., Kim W., Chavez-Araujo R., Higuera-De La Tijera M.F., Singal A.K., Shah V.H., Kamath P.S., Duarte-Rojo A., Charles E.A., Vargas V., Jager M., Rautou P.E., Rincon D., Zamarripa F., Restrepo-Gutiérrez J.C., Torre A., Lucey M.R., Arab J.P., Mathurin P., Louvet A., García-Tsao G., González J.A., Verna E.C., Brown R.S., Argemi J., Fernández-Carillo C., Clemente A., Alvarado-Tapias E., Forrest E., Allison M., Bataller R.
Publicada:
1 feb 2022
Resumen:
INTRODUCTION: Several scoring systems predict mortality in alcohol-associated hepatitis (AH), including the Maddrey discriminant function (mDF) and model for end-stage liver disease (MELD) score developed in the United States, Glasgow alcoholic hepatitis score in the United Kingdom, and age, bilirubin, international normalized ratio, and creatinine score in Spain. To date, no global studies have examined the utility of these scores, nor has the MELD-sodium been evaluated for outcome prediction in AH. In this study, we assessed the accuracy of different scores to predict short-term mortality in AH and investigated additional factors to improve mortality prediction. METHODS: Patients admitted to hospital with a definite or probable AH were recruited by 85 tertiary centers in 11 countries and across 3 continents. Baseline demographic and laboratory variables were obtained. The primary outcome was all-cause mortality at 28 and 90 days. RESULTS: In total, 3,101 patients were eligible for inclusion. After exclusions (n = 520), 2,581 patients were enrolled (74.4% male, median age 48 years, interquartile range 40.9-55.0 years). The median MELD score was 23.5 (interquartile range 20.5-27.8). Mortality at 28 and 90 days was 20% and 30.9%, respectively. The area under the receiver operating characteristic curve for 28-day mortality ranged from 0.776 for MELD-sodium to 0.701 for mDF, and for 90-day mortality, it ranged from 0.773 for MELD to 0.709 for mDF. The area under the receiver operating characteristic curve for mDF to predict death was significantly lower than all other scores. Age added to MELD obtained only a small improvement of AUC. DISCUSSION: These results suggest that the mDF score should no longer be used to assess AH's prognosis. The MELD score has the best performance in predicting short-term mortality.
Filiaciones:
Morales-Arráez D.:
Division of Gastroenterology, Hepatology and Nutrition, Pittsburgh Liver Research Center, University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, United States
Department of Gastroenterology and Hepatology, Hospital Universitario de Canarias, Canarias, Spain
Ventura-Cots M.:
Division of Gastroenterology, Hepatology and Nutrition, Pittsburgh Liver Research Center, University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, United States
Altamirano J.:
Department of Internal Medicine, Hospital Quironsalud, Barcelona, Spain
Abraldes J.G.:
Division of Gastroenterology, Liver Unit, University of Alberta, Edmonton, Canada
Cruz-Lemini M.:
Women and Perinatal Research Group, Obstetrics and Gynecology Department, Sant Pau University Hospital, Barcelona, Spain
Maternal and Child Health and Development Network (SAMID, RD16/0022/0015), Instituto de Salud Carlos Iii, Spanish Ministry of Health, Spain
Thursz M.R.:
Department of Metabolism, Digestive Disease and Reproduction, Imperial College, London, United Kingdom
Atkinson S.R.:
Division of Gastroenterology, Hepatology and Nutrition, Pittsburgh Liver Research Center, University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, United States
Department of Metabolism, Digestive Disease and Reproduction, Imperial College, London, United Kingdom
Sarin S.K.:
Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
Kim W.:
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea
Chavez-Araujo R.:
Hospital das Clinicas, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
Higuera-De La Tijera M.F.:
Servicio de Gastroenterología, Hospital General de México, Mexico
Singal A.K.:
Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, Birmingham, AL, United States
Shah V.H.:
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, United States
Kamath P.S.:
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, United States
Duarte-Rojo A.:
Division of Gastroenterology and Hepatology, Department of Medicine, University of Arkansas for Medical Science, Little Rock, AR, United States
Charles E.A.:
Division of Gastroenterology, Hepatology and Nutrition, Pittsburgh Liver Research Center, University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, United States
Vargas V.:
Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Universidad Autónoma, Barcelona, CIBERehd, Barcelona, Spain
Jager M.:
Service d'Hépatologie, Centre de Référence des Maladies Vasculaires du Foie, Dhu Unity, Pôle des Maladies de l'Appareil Digestif, Hôpital Beaujon, AP-HP, Clichy, France
Rautou P.E.:
Service d'Hépatologie, Centre de Référence des Maladies Vasculaires du Foie, Dhu Unity, Pôle des Maladies de l'Appareil Digestif, Hôpital Beaujon, AP-HP, Clichy, France
Inserm, UMR-970, Paris Cardiovascular Research Center, Parcc, Paris, France
Rincon D.:
Hepatology Department, Hospital General Universitario Gregorio Marañón, CIBERehd and Universidad Complutense, Madrid, Spain
Zamarripa F.:
Gastroenterology, Juarez Hospital, Mexico City, Mexico
Restrepo-Gutiérrez J.C.:
Liver Transplant Program, Hospital Pablo Tobon Uribe, University of Antioquia, Medellin, Colombia
Torre A.:
Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
Lucey M.R.:
Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
Arab J.P.:
Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
Mathurin P.:
Service des Maladies de l'Appareil Digestif et de la Nutrition, Chu Lille, Lille, France
LIRIC-Lille Inflammation Research International Center-U995, Univ. Lille, Inserm, Chu Lille, Lille, France
Louvet A.:
Service des Maladies de l'Appareil Digestif et de la Nutrition, Chu Lille, Lille, France
García-Tsao G.:
Section of Digestive Diseases, Yale University School of Medicine/VA-CT Healthcare System, West Haven, New Haven, CT, United States
González J.A.:
Gastroenterology Department, Hospital Universitario Dr. José e González, Universidad Autónoma de Nuevo León, Monterrey, Mexico
Verna E.C.:
Division of Digestive and Liver Diseases, Department of Medicine and Center for Liver Disease and Transplantation, Columbia University Irving Medical Center, New York, NY, United States
Brown R.S.:
Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, NY, United States
Argemi J.:
Division of Gastroenterology, Hepatology and Nutrition, Pittsburgh Liver Research Center, University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, United States
Liver Unit, Clinica Universidad de Navarra, IdisNA, Pamplona, Spain
Fernández-Carillo C.:
Division of Gastroenterology, Hepatology and Nutrition, Pittsburgh Liver Research Center, University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, United States
Clemente A.:
Division of Gastroenterology, Hepatology and Nutrition, Pittsburgh Liver Research Center, University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, United States
Liver Unit and Digestive Department H.G.U. Gregorio Marañón, Madrid, Spain
CIBERehd, Instituto de Salud Carlos III, Madrid, Spain
Alvarado-Tapias E.:
Division of Gastroenterology, Hepatology and Nutrition, Pittsburgh Liver Research Center, University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, United States
Forrest E.:
Glasgow Royal Infirmary, Glasgow, United Kingdom
Allison M.:
Liver Unit, Cambridge Biomedical Research Centre, Cambridge, United Kingdom
Bataller R.:
Division of Gastroenterology, Hepatology and Nutrition, Pittsburgh Liver Research Center, University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, United States
Open Access
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