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Multicenter Study
. 2022 Feb 1;117(2):301-310.
doi: 10.14309/ajg.0000000000001596.

The MELD Score Is Superior to the Maddrey Discriminant Function Score to Predict Short-Term Mortality in Alcohol-Associated Hepatitis: A Global Study

D Morales-Arráez  1   2 , M Ventura-Cots  1 , J Altamirano  3 , J G Abraldes  4 , M Cruz-Lemini  5 , M R Thursz  6 , S R Atkinson  1   6 , S K Sarin  7 , W Kim  8 , R Chavez-Araujo  9 , M F Higuera-de la Tijera  10 , A K Singal  11 , V H Shah  12 , P S Kamath  12 , A Duarte-Rojo  13 , E A Charles  1 , V Vargas  14 , M Jager  15 , P E Rautou  15   16 , D Rincon  17 , F Zamarripa  18 , J C Restrepo-Gutiérrez  19 , A Torre  20 , M R Lucey  21 , J P Arab  22 , P Mathurin  23   24 , A Louvet  23 , G García-Tsao  25 , J A González  26 , E C Verna  27 , R S Brown Jr  28 , J Argemi  1   29 , C Fernández-Carrillo  1 , A Clemente  1   30   31 , E Alvarado-Tapias  1 , E Forrest  32 , M Allison  33 , R Bataller  1
Affiliations
Multicenter Study

The MELD Score Is Superior to the Maddrey Discriminant Function Score to Predict Short-Term Mortality in Alcohol-Associated Hepatitis: A Global Study

D Morales-Arráez et al. Am J Gastroenterol. .

Erratum in

Abstract

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.

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Conflict of interest statement

Potential competing interests:

The authors declare that there is no conflict of interest.

Figures

Figure 1.
Figure 1.
Flow-chart of patient inclusion. AST: aspartate aminotransferase, ALT: alanine aminotransferase, GGT: gamma glutamyl transferase
Figure 2.
Figure 2.
ROC curves of the different prognostic scores for alcohol-associated hepatitis calculated baseline, used to predict mortality at 28 days, and p-values comparing scores. MELD: model for end-stage liver disease, mDF: Maddrey’s discriminant function, GAHS: Glasgow alcoholic hepatitis score, ABIC: age, bilirubin, international normalized ratio and creatinine score, AUC: area under curve, CI: confidence interval
Figure 3.
Figure 3.
ROC curves of the different prognostic scores for alcohol-associated hepatitis calculated baseline, used to predict mortality at 90 days, and p-values comparing scores. MELD: model for end-stage liver disease, mDF: Maddrey’s discriminant function, GAHS: Glasgow alcoholic hepatitis score, ABIC: age, bilirubin, international normalized ratio and creatinine score, AUC: area under curve, CI: confidence interval
Figure 4.
Figure 4.
Equivalence between the different prognostic scores according to the probability of death. MELD: model for end-stage liver disease, mDF: Maddrey’s discriminant function, GAHS: Glasgow alcoholic hepatitis score, ABIC: age, bilirubin, international normalized ratio and creatinine score
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Comment in

References

    1. Seitz HK, Bataller R, Cortez-Pinto H, et al. Alcoholic liver disease. Nat Rev Dis Primers 2018;4:16. - PubMed
    1. Prado V, Caballería J, Vargas V, et al. Alcoholic hepatitis: How far are we and where are we going? Ann Hepatol 2016;15:463–473. - PubMed
    1. Maddrey WC, Boitnott JK, Bedine MS, et al. Corticosteroid therapy of alcoholic hepatitis. Gastroenterology 1978;75:193–199. - PubMed
    1. Asrani SK, Jennings LW, Kim WR, et al. MELD-GRAIL-Na: Glomerular Filtration Rate and Mortality on Liver-Transplant Waiting List. Hepatology 2019. - PubMed
    1. Srikureja W, Kyulo NL, Runyon BA, et al. MELD score is a better prognostic model than Child-Turcotte-Pugh score or Discriminant Function score in patients with alcoholic hepatitis. J Hepatol 2005;42:700–706. - PubMed

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