Utility of the Mayo End-Stage Liver Disease (MELD) score in assessing prognosis of patients with alcoholic hepatitis

Abstract

Background: Alcoholic hepatitis is characterized by acute, or acute-on-chronic hepatic failure and associated with a high mortality. Specific therapies should be considered for those at high risk of mortality. The Mayo End-Stage Liver Disease (MELD) score is a marker of disease severity and mortality in persons with chronic alcoholic liver disease. Our aims were to assess the utility of the MELD score as a predictor of short-term mortality in persons with alcoholic hepatitis.

Methods: We assessed the utility of the MELD score and compared it with the Discriminant Function (DF) as a predictor of mortality in 34 patients hospitalized with alcoholic hepatitis.

Results: The area under the curve of a receiver operating characteristic curve for the MELD score was 0.82 (confidence intervals 0.65-0.98), and for the DF was 0.86 (confidence intervals 0.70-1.00). However, the sensitivity and specificity in predicting 30-day mortality for a MELD score of greater than 11 was 86% and 81%, but for a DF greater than 32 was 86% and 48% respectively. The presence of ascites and bilirubin greater than 8 mg/dL were also highly predictive of mortality with a sensitivity of 71% and a specificity of 96%.

Conclusions: Alcoholic hepatitis remains associated with a high mortality in hospitalized patients. The MELD score performs as well as the DF in predicting mortality at 30 days. A MELD score of greater than 11, or the presence of both ascites and an elevated bilirubin greater than 8 mg/dL should prompt consideration of specific therapeutic interventions to reduce mortality.

Figure 1

Receiver Operating Characteristic curves for the utility of the MELD score for prediction of 30-day mortality in persons hospitalized with alcoholic hepatitis. The area under the curve (AUC) represents the predictive utility of the MELD score and is 0.82 (confidence intervals 0.65–0.98).

Figure 2

Receiver Operating Characteristic curves for the utility of the Discriminant Function (DF) for prediction of 30-day mortality in persons hospitalized with alcoholic hepatitis. The area under the curve (AUC) represents the predictive utility of the DF score and is 0.86 (confidence intervals 0.70–1.00).