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Observational Study
. 2022 Jul;50(7):3000605221109385.
doi: 10.1177/03000605221109385.

HDL-C levels added to the MELD score improves 30-day mortality prediction in Asian patients with cirrhosis

Yue Wang  1 , Wenjuan Shen  2 , Fang Huang  3 , Chenyan Yu  2 , Liting Xi  2 , Jingwen Gao  2 , Minyue Yin  2 , Xiaolin Liu  2 , Jiaxi Lin  2 , Lu Liu  2 , Huixian Zhang  2 , Jinzhou Zhu  2 , Yu Hong  2
Affiliations
Observational Study

HDL-C levels added to the MELD score improves 30-day mortality prediction in Asian patients with cirrhosis

Yue Wang et al. J Int Med Res. 2022 Jul.

Abstract

Objectives: Lower high-density lipoprotein cholesterol (HDL-C) levels have been observed in chronic liver disease patients. The aim of this study was to develop a model that incorporates HDL-C levels and the Model for End-stage Liver Disease (MELD) score to predict 30-day mortality in Asian cirrhosis patients.

Methods: Cirrhosis patients were recruited from two hospitals in this retrospective observational study. Propensity score matching was used. The model's performance was evaluated, including its ability to predict 30-day mortality, accuracy, and clinical utility. Net reclassification improvement (NRI) and integrated discrimination improvement (IDI) were calculated.

Results: The HDL-C + MELD model showed good ability to predict 30-day mortality (area under the curve, 0.784; sensitivity, 0.797; specificity, 0.632), which was better than that of the MELD score alone. It also showed good calibration and a net benefit for all patients, which was better than that of the MELD score, except at the threshold probability. NRI and IDI results confirmed that adding HDL-C levels to the MELD score improved the model's performance in predicting 30-day mortality.

Conclusion: We added HDL-C levels to the MELD score to predict 30-day mortality in Asian patients with cirrhosis. The HDLC + MELD model shows good ability to predict 30-day mortality and clinical utility.

Keywords: Cirrhosis; Model for End-stage Liver Disease score; high-density lipoprotein cholesterol; integrated discrimination improvement; net reclassification improvement; nomogram; predictive model.

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Conflict of interest statement

Declaration of conflicting interests: The authors declare that they have no conflict of interest.

Figures

Figure 1.
Figure 1.
Flowchart of participants’ inclusion at two centers.
Figure 2.
Figure 2.
Nomogram to estimate the 30-day mortality risk.
Figure 3.
Figure 3.
Receiver operating characteristic curve.
Figure 4.
Figure 4.
HDLC+MELD calibration curve for 30-day mortality. HDLC+MELD, high-density lipoprotein cholesterol when added to the Model for End-stage Liver Disease.
Figure 5.
Figure 5.
Decision curve analysis for the nomogram.
See this image and copyright information in PMC

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