MELD 3.0 adequately predicts mortality and renal replacement therapy requirements in patients with alcohol-associated hepatitis

Díaz, Luis Antonio; Fuentes‐López, Eduardo; Ayares, Gustavo; Idalsoaga, Francisco; Arnold, Jorge; Ayala-Valverde, María; Pérez, Diego; Gómez, Jaime; Escarate, Rodrigo; Villalón, Alejandro; Ramírez, Carolina A.; Hernández-Tejero, María; Zhang, Wei; Qian, Steve; Simonetto, Douglas A.; Ahn, Joseph; Buryska, Seth; Dunn, Winston; Mehta, Heer; Agrawal, Rohit; Cabezas, Joaquín; García-Carrera, Inés; Cuyàs, Berta; Poca, María; Soriano, Germán; Sarin, Shiv Kumar; Maiwall, Rakhi; Jalal, Prasun K.; Abdulsada, Saba; Tijera, Fátima Higuera-de la; Kulkarni, Anand V.; Rao, Padaki Nagaraja; Salazar, Patricia Guerra; Skladaný, Ľubomír; Bystrianska, Natália; Clemente‐Sánchez, Ana; Villaseca-Gómez, Clara; Haider, Tehseen; Chacko, Kristina; Romero, Gustavo; Pollarsky, Florencia; Restrepo, Juan Carlos; Castro-Sanchez, Susana; Toro, Luis; Yaquich, Pamela; Mendizábal, Manuel; Garrido, María Laura; Marciano, Sebastián; Dirchwolf, Melisa; Vargas, Vı́ctor; Jimenez, César; Louvet, Alexandre; García–Tsao, Guadalupe; Roblero, Juan Pablo; Abraldes, Juan G.; Shah, Vijay H.; Kamath, Patrick S.; Arrese, Marco; Singal, Ashwani K.; Bataller, Ramón; Arab, Juan Pablo

doi:10.1016/j.jhepr.2023.100727

Cited by 5 publications

(2 citation statements)

References 46 publications

(65 reference statements)

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“…Among static models, the MELD score has been demonstrated to be the most effective static scoring system 26,27 . The new MELD 3.0 score was recently released, evidencing a similar performance to the original MELD score in terms of mortality prediction, but with better performance to predict the need for renal replacement therapy 28 …”

Section: Use Of Prognostic Scores In Alcohol‐associated Hepatitismentioning

confidence: 99%

Review article: Current indications and selection criteria for early liver transplantation in severe alcohol‐associated hepatitis

Ramirez‐Cadiz,

Blaney,

Kubanek

et al. 2024

Aliment Pharmacol Ther

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SummaryBackgroundAlcohol‐associated hepatitis (AH) is a severe inflammatory form of alcohol‐associated liver disease (ALD) that carries a high mortality rate. Early liver transplantation for severe AH is increasingly available. However, specific criteria for referral and selection remain a subject of debate.AimsTo provide a narrative review of the natural history, diagnostic criteria and indications for referral for early liver transplantation for severe AH.MethodsWe searched PubMed for articles published through August 2023. Key search terms were ‘alcoholic hepatitis,’ ‘alcohol‐associated hepatitis,’ ‘abstinence,’ ‘alcohol relapse,’ and ‘liver transplantation.’ResultsPreviously, a six‐month period of alcohol abstinence was required before patients with ALD were considered for liver transplantation. However, studies in recent years have demonstrated that, among carefully selected patients, patients who received early transplants have much higher survival rates than patients with similarly severe disease who did not undergo transplants (77% vs. 23%). Despite these successes, early liver transplantation remains controversial, as these patients have typically not undergone treatment for alcohol use disorder, with the ensuing risk of returning to alcohol use.ConclusionsWhile early liver transplantation for AH has survival benefits, many patients would not have received treatment for alcohol use disorder. An integrated approach to evaluating candidacy for early liver transplantation is needed.

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Section: Use Of Prognostic Scores In Alcohol‐associated Hepatitismentioning

confidence: 99%

Review article: Current indications and selection criteria for early liver transplantation in severe alcohol‐associated hepatitis

Ramirez‐Cadiz,

Blaney,

Kubanek

et al. 2024

Aliment Pharmacol Ther

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“…Further analysis comparing several scores showed the MELD score to be the best score in assessing short-term mortality risk with ROC > 0.77 (157). Although MELD-Na and MELD are similar in predicting short-term mortality in AH (172), MELD 3.0 has been recently shown to have equivalent performance to MELD and may have utility to predict need for renal replacement therapy though further validation is needed (173).…”

Section: Ahmentioning

confidence: 99%

ACG Clinical Guideline: Alcohol-Associated Liver Disease

Jophlin,

Singal,

Bataller

et al. 2023

Am J Gastroenterol

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Alcohol-associated liver disease (ALD) is the most common cause of advanced hepatic disease and frequent indication for liver transplantation worldwide. With harmful alcohol use as the primary risk factor, increasing alcohol use over the past decade has resulted in rapid growth of the ALD-related healthcare burden. The spectrum of ALD ranges from early asymptomatic liver injury to advanced disease with decompensation and portal hypertension. Compared with those with other etiologies of liver disease, patients with ALD progress faster and more often present at an advanced stage. A unique phenotype of advanced disease is alcohol-associated hepatitis (AH) presenting with rapid onset or worsening of jaundice, and acute on chronic liver failure in severe forms conveying a 1-month mortality risk of 20%–50%. The model for end stage disease score is the most accurate score to stratify AH severity (>20 defined as severe disease). Corticosteroids are currently the only available therapeutic with proven efficacy for patients with severe AH, providing survival benefit at 1 month in 50%–60% of patients. Abstinence of alcohol use, a crucial determinant of long-term outcomes, is challenging to achieve in ALD patients with concurrent alcohol use disorder (AUD). As patients with ALD are rarely treated for AUD, strategies are needed to overcome barriers to AUD treatment in patients with ALD and to promote a multidisciplinary integrated care model with hepatology, addiction medicine providers, and social workers to comprehensively manage the dual pathologies of liver disease and of AUD. Liver transplantation, a definitive treatment option in patients with advanced cirrhosis, should be considered in selected patients with AH, who are unresponsive to medical therapy and have a low risk of relapse to posttransplant alcohol use. Level of evidence and strength of recommendations were evaluated using the Grading of Recommendations, Assessment, Development, and Evaluations system. This guideline was developed under the American College of Gastroenterology Practice Parameters Committee.

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New insights into the molecular basis of alcohol abstinence and relapse in alcohol-associated liver disease

Diaz,

Winder,

Leggio

et al. 2023

Hepatology

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Alcohol use disorder (AUD) remains a significant public health concern, affecting around 5% of adults worldwide. Novel pathways of damage have been described during the last years, providing insight into the mechanism of injury due to alcohol misuse beyond the direct effect of ethanol byproducts on the liver parenchyma and neurobehavioral mechanisms. Thus, the gut-liver-brain axis and immune system involvement could be therapeutic targets for AUD. In particular, a change in gut microbiota composition and function, especially bile acid homeostasis, and these changes can improve after alcohol cessation. Alcohol can also directly disrupt intestinal and blood-brain barriers. Activation of the immune system can be triggered by intestinal barrier dysfunction and translocation of bacteria, pathogen-associated molecular patterns (such as lipopolysaccharide), cytokines, and damage-associated molecular patterns. These factors in turn promote liver and brain inflammation and progression of liver fibrosis. Other involved mechanisms include oxidative stress, apoptosis, autophagy, and the release of extracellular vesicles and miRNA from hepatocytes. Potential therapeutic targets include gut microbiota (probiotics and fecal microbiota transplantation), neuroinflammatory pathways, as well as neuroendocrine pathways, e.g.: the ghrelin system (ghrelin receptor blockade), incretin mimetics (GLP-1 analogs), and the mineralocorticoid receptor system (spironolactone). In addition, support with psychological and behavioral treatments is essential to address the multiple dimensions of AUD. In the future, a personalized approach considering these novel targets can contribute to significantly decreasing the alcohol-related burden of disease.

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MELD 3.0 adequately predicts mortality and renal replacement therapy requirements in patients with alcohol-associated hepatitis

Cited by 5 publications

References 46 publications

Review article: Current indications and selection criteria for early liver transplantation in severe alcohol‐associated hepatitis

Review article: Current indications and selection criteria for early liver transplantation in severe alcohol‐associated hepatitis

ACG Clinical Guideline: Alcohol-Associated Liver Disease

New insights into the molecular basis of alcohol abstinence and relapse in alcohol-associated liver disease

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