MELD best predictor of outcomes in alcohol-related liver disease: study

A recent study describes the natural history of alcohol-associated liver disease (ALD) and the risks of outcomes based on the model for end-stage liver disease (MELD) score across the ALD spectrum.

A total of 240 patients died from liver disease or underwent liver transplantation (LT) during a median follow-up of 4.9 years, while 114 died from nonliver causes.

Various outcomes were noted across the spectrum of ALD. The cumulative incidence of liver-related death or LT was 47 percent in patients with decompensated cirrhosis and 40 percent in those with alcohol-associated hepatitis compared with 7.4 percent and 13 percent in patients without cirrhosis and with compensated cirrhosis, respectively.

MELD was the best predictor of outcomes, with an area under the curve of 0.863 for mortality/LT at 1 year. However, MELD3.0 and the Child-Turcotte-Pugh score also demonstrated comparable predictive capacity.

“Risk of liver-related outcomes were tabulated for integer values of the MELD score,” the investigators said. “Risk estimates based on the MELD were well calibrated in an external cohort.”

This study included 734 patients with biopsy-proven ALD. The investigators assessed prognostic scores using dynamic area under the curve and C-index. They also derived risk estimates for morbidity and mortality for MELD and validated these in an external cohort.

“ALD is a common cause of morbidity and premature mortality,” said the investigators, noting that “most prognostic scores have been defined in the short term.”