MELD, MELD 3.0, versus Child score to predict mortality after acute variceal hemorrhage: A multicenter US cohort.
Journal
Hepatology communications
ISSN: 2471-254X
Titre abrégé: Hepatol Commun
Pays: United States
ID NLM: 101695860
Informations de publication
Date de publication:
01 10 2023
01 10 2023
Historique:
received:
13
04
2023
accepted:
20
07
2023
medline:
12
9
2023
pubmed:
11
9
2023
entrez:
11
9
2023
Statut:
epublish
Résumé
Acute variceal hemorrhage is a major decompensating event in patients with cirrhosis and is associated with high 6-week mortality risk. Many prognostic models based on clinical and laboratory parameters have been developed to risk stratify patients on index bleeding presentation, including those based on the Model for End-Stage Liver Disease (MELD) and Child-Turcotte-Pugh (CTP). However, consensus on model performance remains unclear. Using a large US multicenter cohort of hospitalized patients with cirrhosis who presented with acute variceal hemorrhage, this study evaluates, recalibrates, and compares liver severity index-based models, including the more recent MELD 3.0 model, to investigate their predictive performance on 6-week mortality. Models were also recalibrated and externally validated using additional external centers. All recalibrated MELD-based and CTP-based models had excellent discrimination to identify patients at higher risk for 6-week mortality on initial presentation. The recalibrated CTP score model maintained the best calibration and performance within the validation cohort. Patients with low CTP scores (Class A, score 5-6) were strongly associated with < 5% mortality, while high CTP score (Class C, score > 9) were associated with > 20% mortality. Use of liver severity index-based models accurately predict 6-week mortality risk for patients admitted to the hospital with acute variceal hemorrhage and supports the utilization of these models in future clinical trials as well as their use in clinical practice.
Sections du résumé
BACKGROUND
Acute variceal hemorrhage is a major decompensating event in patients with cirrhosis and is associated with high 6-week mortality risk. Many prognostic models based on clinical and laboratory parameters have been developed to risk stratify patients on index bleeding presentation, including those based on the Model for End-Stage Liver Disease (MELD) and Child-Turcotte-Pugh (CTP). However, consensus on model performance remains unclear.
METHODS
Using a large US multicenter cohort of hospitalized patients with cirrhosis who presented with acute variceal hemorrhage, this study evaluates, recalibrates, and compares liver severity index-based models, including the more recent MELD 3.0 model, to investigate their predictive performance on 6-week mortality. Models were also recalibrated and externally validated using additional external centers.
RESULTS
All recalibrated MELD-based and CTP-based models had excellent discrimination to identify patients at higher risk for 6-week mortality on initial presentation. The recalibrated CTP score model maintained the best calibration and performance within the validation cohort. Patients with low CTP scores (Class A, score 5-6) were strongly associated with < 5% mortality, while high CTP score (Class C, score > 9) were associated with > 20% mortality.
CONCLUSION
Use of liver severity index-based models accurately predict 6-week mortality risk for patients admitted to the hospital with acute variceal hemorrhage and supports the utilization of these models in future clinical trials as well as their use in clinical practice.
Identifiants
pubmed: 37695092
doi: 10.1097/HC9.0000000000000258
pii: 02009842-202310010-00005
pmc: PMC10497247
pii:
doi:
Types de publication
Multicenter Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Association for the Study of Liver Diseases.
Références
J Hepatol. 2017 Sep 13;68(1):73-81
pubmed: 28918131
Hepatology. 2001 Feb;33(2):464-70
pubmed: 11172350
Dig Dis Sci. 2023 Mar;68(3):1042-1050
pubmed: 36376577
J Hepatol. 2005;42 Suppl(1):S100-7
pubmed: 15777564
J Hepatol. 2003;38 Suppl 1:S54-68
pubmed: 12591186
N Engl J Med. 2010 Jun 24;362(25):2370-9
pubmed: 20573925
Gastroenterology. 2014 Feb;146(2):412-19.e3
pubmed: 24148622
N Engl J Med. 2021 Mar 4;384(9):818-828
pubmed: 33657294
J Hepatol. 2013 Jan;58(1):45-50
pubmed: 22940408
Gut. 2008 Jun;57(6):814-20
pubmed: 18250126
BMJ. 2012 Feb 14;344:e813
pubmed: 22334559
J Hepatol. 2022 Apr;76(4):959-974
pubmed: 35120736
N Engl J Med. 2015 Apr 23;372(17):1619-28
pubmed: 25901427
J Clin Gastroenterol. 2017 May-Jun;51(5):446-453
pubmed: 27779613
Hepatology. 2017 Jan;65(1):310-335
pubmed: 27786365
Gastroenterology. 1999 Sep;117(3):626-31
pubmed: 10464138
Hepatology. 2019 Jan;69(1):282-293
pubmed: 30014519
Hepatology. 2003 Sep;38(3):599-612
pubmed: 12939586
Hepatology. 2007 Sep;46(3):922-38
pubmed: 17879356
Gastroenterology. 2021 Dec;161(6):1887-1895.e4
pubmed: 34481845
J Hepatol. 2000 Jan;32(1):19-24
pubmed: 10673062
Clin Gastroenterol Hepatol. 2009 Dec;7(12):1347-54
pubmed: 19699816
J Hepatol. 2008 Feb;48(2):229-36
pubmed: 18093686
J Gastroenterol Hepatol. 2017 Nov;32(11):1859-1866
pubmed: 28271564
Radiat Oncol. 2020 May 14;15(1):109
pubmed: 32410693
J Hepatol. 2015 Sep;63(3):743-52
pubmed: 26047908