MELD 3.0 validated as superior mortality predictor in Asians with cirrhosis

The latest update of the model for end-stage liver disease (MELD), MELD 3.0, predicts mortality in multiethnic Asian patients hospitalized with cirrhosis with greater accuracy than previous models, according to a study from Singapore.

When applied to 862 cirrhotic inpatients (median age 71.0 years, 65.4 percent male, 75.8 percent Chinese) in Singapore General Hospital, MELD 3.0 had the best performance for predicting 30-day mortality, with an area under the receiver operating characteristic curve (AUROC) of 0.823 compared with 0.793 for MELD-Na and 0.783 for MELD. [JGH Open 2024;8:e13098]

The optimal cutoff value for predicting 30-day mortality with MELD 3.0 was 19, for a sensitivity of 67.4 percent and specificity of 82.4 percent. Compared with those who had a score of ≤19, patients with a score >19 (high risk) had a much shorter survival time (median, 98.0 vs 390.0 days) and a higher proportion of deaths within 30 days (68.8 percent vs 43.0 percent).

Likewise, MELD 3.0 performed better than MELD-Na and MELD for predicting mortality at 90 days (AUROC, 0.754 vs 0.724 and 0.707, respectively) and at 365 days (AUROC, 0.682 vs 0.654 and 0.644, respectively). The optimal threshold for predicting 90- and 365-day mortalities with MELD 3.0 were 17 and 13, respectively.

In the study population, 55.5 percent of patients had Child-Turcotte-Pugh class A, while 35.5 percent and 9.0 percent had class B and C, respectively. The median MELD 3.0, MELD-Na, and MELD scores were 12.2, 11.0, and 10.3, respectively. The median follow-up time was 51.9 months.

Better risk stratification

MELD 3.0 refines mortality prediction for cirrhosis patients by addressing the limitations of the original MELD and its derivative MELD-Na, according to the investigators.

First, MELD 3.0 lowers the ceiling for serum creatinine, from 4.0 mg/dL in MELD-Na and MELD to 3.0 mg/dL. This is important, they said, because elevated creatinine can be caused by factors other than severe liver disease, such as the metabolic dysfunction-associated steatotic liver disease. In this regard, MELD-Na and MELD might overestimate the severity of a patient’s condition.

Additionally, MELD 3.0 incorporates sex as a factor, recognizing that females often have lower creatinine levels compared with males who had similar kidney function due to having smaller muscle mass. This adjustment facilitates more accurate prognoses in females with cirrhosis, the investigators pointed out.

The present study is the first to validate the performance of MELD 3.0 in a multiethnic Asian population of patients with cirrhosis, particularly for predicting 30-day mortality, and has shown that MELD 3.0 performed better than the MELD-Na and MELD, they continued.

“MELD 3.0 could be a valuable tool to facilitate the allocation of the scarce supply of liver for transplantation by more accurately risk stratifying patients with liver cirrhosis,” the investigators said. “We acknowledge that the cutoff MELD 3.0 score of >19 to identify patients with excessively high mortality will require further validation from larger multicentre studies before it can be implemented in clinical use.”