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Utility of the Mayo End-Stage Liver Disease (MELD) score in assessing prognosis of patients with alcoholic hepatitis.

Sheth M, Riggs M, Patel T - BMC Gastroenterol (2002)

Bottom Line: 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%.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.

View Article: PubMed Central - HTML - PubMed

Affiliation: Division of Gastroenterology, Scott and White Clinic, Texas A&M University Health Science Center College of Medicine, Temple, Texas, USA. msheth@swmail.sw.org

ABSTRACT

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.

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Receiver Operating Characteristic curves for the utility of the MELD score for prediction of 30-day mortality in persons hospitalized with alcoholic hepatitis. The area under the curve (AUC) represents the predictive utility of the MELD score and is 0.82 (confidence intervals 0.65–0.98).
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Figure 1: Receiver Operating Characteristic curves for the utility of the MELD score for prediction of 30-day mortality in persons hospitalized with alcoholic hepatitis. The area under the curve (AUC) represents the predictive utility of the MELD score and is 0.82 (confidence intervals 0.65–0.98).

Mentions: The mean MELD score at admission for survivors at 30-days was 4.3, while for non-survivors was 18.7. The predictive utility of the MELD score for prediction of mortality at 30 days was determined by generating a receiver operating characteristic curve. The area under the curve (AUC) for the MELD score was 0.82 (confidence intervals 0.65–0.98) (Fig 1). Using a cut-off of a MELD score of greater than 11, the sensitivity and specificity of the MELD score for prediction of 30-day mortality were 86% and 82% respectively.


Utility of the Mayo End-Stage Liver Disease (MELD) score in assessing prognosis of patients with alcoholic hepatitis.

Sheth M, Riggs M, Patel T - BMC Gastroenterol (2002)

Receiver Operating Characteristic curves for the utility of the MELD score for prediction of 30-day mortality in persons hospitalized with alcoholic hepatitis. The area under the curve (AUC) represents the predictive utility of the MELD score and is 0.82 (confidence intervals 0.65–0.98).
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC65516&req=5

Figure 1: Receiver Operating Characteristic curves for the utility of the MELD score for prediction of 30-day mortality in persons hospitalized with alcoholic hepatitis. The area under the curve (AUC) represents the predictive utility of the MELD score and is 0.82 (confidence intervals 0.65–0.98).
Mentions: The mean MELD score at admission for survivors at 30-days was 4.3, while for non-survivors was 18.7. The predictive utility of the MELD score for prediction of mortality at 30 days was determined by generating a receiver operating characteristic curve. The area under the curve (AUC) for the MELD score was 0.82 (confidence intervals 0.65–0.98) (Fig 1). Using a cut-off of a MELD score of greater than 11, the sensitivity and specificity of the MELD score for prediction of 30-day mortality were 86% and 82% respectively.

Bottom Line: 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%.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.

View Article: PubMed Central - HTML - PubMed

Affiliation: Division of Gastroenterology, Scott and White Clinic, Texas A&M University Health Science Center College of Medicine, Temple, Texas, USA. msheth@swmail.sw.org

ABSTRACT

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.

Show MeSH
Related in: MedlinePlus