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. 2025 Jul 17.
doi: 10.14309/ajg.0000000000003649. Online ahead of print.

Defining Risk in Alcohol-Associated Liver Disease Using the Model for End-Stage Liver Disease

Richard Parker  1   2 , Guru Aithal  3 , Michael Allison  4 , Mayur Brahmania  5 , Ewan Forrest  6   7 , Hannes Hagström  8   9 , Brian T Lee  10   11 , Soyoun J Park MD  10 , Anne McCune  12 , Timothy Morgan  13   14 , Keval Naik  4 , Steven Masson  15 , Neil Rajoriya  16 , Devanshi Seth  17   18   19 , Ken Liu  19   20 , John Chetwood  19   20 , Esperance Schaefer  21 , Jay Luther  21 , Russell Goodman  21 , Ian Rowe  1   2 ; WALDO study group
Affiliations

Defining Risk in Alcohol-Associated Liver Disease Using the Model for End-Stage Liver Disease

Richard Parker et al. Am J Gastroenterol. .

Abstract

Introduction: Alcohol-associated liver disease (ALD) is a common cause of morbidity and premature mortality. Most prognostic scores have been defined in the short term. We used a large retrospective cohort of patients with ALD to describe the natural history of ALD and to define risk prediction in the longer term, taking nonliver mortality into account.

Methods: The WALDO cohort includes 734 patients with biopsy-proven ALD. Prognostic scores were assessed with dynamic area under the curve and C-index. Risk estimates for morbidity and mortality were derived for the model for end-stage liver disease (MELD) and validated in an external cohort.

Results: During a median follow-up of 4.9 years, 240 patients died from liver disease or underwent liver transplantation (LT), and 114 patients died from nonliver causes. Outcomes varied across the spectrum of ALD: The cumulative incidence of liver-related death or LT in people with decompensated cirrhosis or alcohol-associated hepatitis was 47% and 40%, respectively, compared with 7.4% in patients without cirrhosis and 13% in compensated cirrhosis. MELD was the best predictor of outcomes: (area under the curve for mortality/LT at 1 year was 0.853), although MELD3.0 and the Child-Turcotte-Pugh score performed similarly. Risk of liver-related outcomes were tabulated for integer values of the MELD score. Risk estimates based on the MELD were well calibrated in an external cohort.

Discussion: These data illustrate the natural history of ALD and define the risks of outcomes based on the MELD score across the spectrum of disease.

Keywords: alcohol associated liver disease; natural history; risk prediction.

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