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Multicenter Study
. 2023 Mar;68(3):1042-1050.
doi: 10.1007/s10620-022-07744-w. Epub 2022 Nov 14.

MELD-Lactate Predicts Poor Outcome in Variceal Bleeding in Cirrhosis

Thomas Horvatits  1 , Nadim Mahmud  2   3 , Marina Serper  2   3 , Oliver Seiz  4 , Dominik Reher  4 , Andreas Drolz  4 , Naveed Sarnast  5 , Wenyi Gu  6 , Hans Peter Erasmus  6 , Gabriel Allo  7 , Phillip Ferstl  6 , Sebastian Wittmann  4 , Felix Piecha  4 , Stefan Groth  8 , Stefan Zeuzem  6 , Christoph Schramm  7 , Samuel Huber  4 , Thomas Rösch  8 , Ansgar W Lohse  4 , Jonel Trebicka  6 , Gerald Ogola  5 , Sumeet K Asrani  5 , Johannes Kluwe  4
Affiliations
Multicenter Study

MELD-Lactate Predicts Poor Outcome in Variceal Bleeding in Cirrhosis

Thomas Horvatits et al. Dig Dis Sci. 2023 Mar.

Abstract

Background: Predictors of poor outcome associated with variceal bleeding remain suboptimal. In patients with cirrhosis, serum lactate combined with Model for End-Stage Liver Disease (MELD-LA) improved prediction across heterogeneous populations. However, prognostic properties have not yet been assessed in the context of variceal bleeding.

Aims: We aimed to evaluate the predictive performance of MELD-LA compared to MELD, lactate, and nadir hemoglobin in cirrhosis patients with variceal bleeding.

Methods: In this multicenter study, we identified 472 patients with variceal bleeding from a German primary cohort (University Hospitals Hamburg/Frankfurt/Cologne), and two independent external validation cohorts [Veterans Affairs (VA), Baylor University]. Discrimination for 30-day mortality was analyzed and scores were compared. MELD-LA was evaluated separately in validation cohorts to ensure consistency of findings.

Results: In contrast to nadir hemoglobin, MELD and peak-lactate at time of bleeding were significantly higher in 30-day non-survivors in the primary cohort (p = 0.708; p < 0.001). MELD-LA had excellent discrimination for 30-day mortality (AUROC 0.82, 95% CI 0.76-0.88), better than MELD and peak-lactate (AUROC 0.78, 95% CI 0.71-0.84; AUROC 0.73, 95% CI 0.66-0.81). MELD-LA predicted 30-day mortality independently of age, sex, severity of liver disease and vasopressor support (HR 1.29 per 1-point-increase of MELD-LA; 95% CI 1.19-1.41; p < 0.001). Similarly, MELD-LA demonstrated excellent discrimination for 30-day mortality in the VA (AUROC = 0.86, 95% CI 0.79-0.93) and Baylor cohort (AUROC = 0.85, 95% CI 0.74-0.95).

Conclusions: MELD-LA significantly improves discrimination of short-term mortality associated with variceal bleeding, compared to MELD, peak-lactate and nadir hemoglobin. Thus, MELD-LA might represent a useful and objective marker for risk assessment and therapeutic intervention in patients with variceal bleeding.

Keywords: Cirrhosis; GI bleeding; MELD-lactate; Variceal bleeding.

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Conflict of interest statement

Conflict of interest All authors declare that they have no conflict of interests regarding this manuscript. All authors approved the manuscript. Authors had authority over manuscript preparation and the decision to submit the manuscript for publication. The participating centers take responsibility for the integrity of the original data and data analyses contributed.

Figures

Fig. 1
Fig. 1
A–C Receiver operating curve analysis in prediction of 30-day mortality. Receiver operating curve analysis of MELD-LA, MELD and peak serum lactate and in prediction of 30-day mortality in the primary German validation cohort (A), the VA validation cohort (B) and the Baylor cohort (C) (MELD model for endstage liver disease, MELD-LA incorporation of serum lactate into the MELD score)
Fig. 2
Fig. 2
Kaplan Meier curve. 30-day mortality rate was significantly higher in patients with MELD-LA > 14.4 compared to those with MELD-LA ≤ 14.4; A in the German primary cohort; B in the VA population and C the Baylor cohort
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