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-Carillo 1 , A Clemente 1 30 31 , E Alvarado-Tapias 1 , E Forrest 32 , M Allison 33 , R Bataller 1
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.