Utility of the Mayo End-Stage Liver Disease (MELD) score in assessing prognosis of patients with alcoholic hepatitis.
BACKGROUND
Alcoholic hepatitis is characterized by acute, or acute-on-chronic hepatic failure and associated with a high mortality. Specific therapies should be considered for those at high risk of mortality. The Mayo End-Stage Liver Disease (MELD) score is a marker of disease severity and mortality in persons with chronic alcoholic liver disease. Our aims were to assess the utility of the MELD score as a predictor of short-term mortality in persons with alcoholic hepatitis.


METHODS
We assessed the utility of the MELD score and compared it with the Discriminant Function (DF) as a predictor of mortality in 34 patients hospitalized with alcoholic hepatitis.


RESULTS
The area under the curve of a receiver operating characteristic curve for the MELD score was 0.82 (confidence intervals 0.65-0.98), and for the DF was 0.86 (confidence intervals 0.70-1.00). However, the sensitivity and specificity in predicting 30-day mortality for a MELD score of greater than 11 was 86% and 81%, but for a DF greater than 32 was 86% and 48% respectively. The presence of ascites and bilirubin greater than 8 mg/dL were also highly predictive of mortality with a sensitivity of 71% and a specificity of 96%.


CONCLUSIONS
Alcoholic hepatitis remains associated with a high mortality in hospitalized patients. The MELD score performs as well as the DF in predicting mortality at 30 days. A MELD score of greater than 11, or the presence of both ascites and an elevated bilirubin greater than 8 mg/dL should prompt consideration of specific therapeutic interventions to reduce mortality.
Sheth
Milan
M
Division of Gastroenterology, Scott and White Clinic, Texas A&M University Health Science Center College of Medicine, Temple, Texas, USA. msheth@swmail.sw.org
Riggs
Mark
M
Patel
Tushar
T
D001663:Bilirubin / Q000097:blood; D003404:Creatinine / Q000097:blood; D016002:Discriminant Analysis; D005260:Female; D006519:Hepatitis, Alcoholic / Q000145:classification / Q000401:mortality*; D006760:Hospitalization; D006801:Humans; D017093:Liver Failure / Q000145:classification / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012372:ROC Curve; D012720:Severity of Illness Index
D003404:Creatinine; D001663:Bilirubin