Title :

Relationship between updated MELD and prognosis in alcohol-associated hepatitis: Opportunities for more efficient trial design.

Author(s) :

Al-Karaghouli, M. [Auteur]
Ventura-Cots, M. [Auteur]
Wong, Y. J. [Auteur]
Genesca, J. [Auteur]
Bosques, F. [Auteur]
Brown, R. S. [Auteur]
Mathurin, P. [Auteur]
Louvet, Alexandre [Auteur]
Institut de Recherche Translationnelle sur l'Inflammation (INFINITE) - U1286
Shawcross, D. [Auteur]
Vargas, V. [Auteur]
Verna, E. C. [Auteur]
Schnabl, B. [Auteur]
Caballeria, J. [Auteur]
Shah, V. J. [Auteur]
Kamath, P. S. [Auteur]
Lucey, M. R. [Auteur]
Garcia-Tsao, G. [Auteur]
Bataller, R. [Auteur]
Abraldes, J. G. [Auteur]

Journal title :

Hepatology Communications

Abbreviated title :

Hepatol Commun

Volume number :

8

Pages :

e0495

Publisher :

Wolters Kluwer Health Inc. on behalf of the American Association for The Study of Liver Diseases

Publication date :

2024-08-18

ISSN :

2471-254X

HAL domain(s) :

Sciences du Vivant [q-bio]

English abstract : [en]

Background: Alcohol-associated hepatitis (AH) is associated with significant mortality. Model for End-Stage Liver Disease (MELD) score is used to predict short-term mortality and aid in treatment decisions. MELD is ...
Show more >Background: Alcohol-associated hepatitis (AH) is associated with significant mortality. Model for End-Stage Liver Disease (MELD) score is used to predict short-term mortality and aid in treatment decisions. MELD is frequently updated in the course of AH. However, once the most updated MELD is known, it is uncertain if previous ones still have prognostic value, which might be relevant for transplant allocation and trial design. We aimed to investigate the predictive performance of updated MELDs in a prospectively collected cohort of patients with AH by the InTeam consortium. Methods: Three hundred seven patients (with 859 MELD values within 60 d of admission) fulfilled the inclusion criteria. The main endpoint was time to death or transplant up to 90 days. We used a joint model approach to assess the predictive value of updated MELDs. Results: Updated MELD measurements had a strong prognostic value for death/transplant (HR: 1.20, 95% CI: 1.14–1.27) (p < 0.0001). Previous MELD values did not add predictive value to the most current MELD. We also showed that MELD at day 28 (MELD28) had a significant predictive value for subsequent mortality/transplant in a landmark analysis (HR: 1.18, 95% CI: 1.12–1.23). We show that the use of an ordinal scale including death, transplant, and MELD28 as a trial outcome could substantially reduce the sample size required to demonstrate short-term benefit of an intervention. Conclusion: We show that updated MELDs during the trajectory of AH predict subsequent mortality or the need for transplant. MELD28 inclusion in an ordinal outcome (together with death or transplant) could increase the efficiency of randomized controlled trials.Show less >

Language :

Anglais

Audience :

Internationale

Popular science :

Non

Administrative institution(s) :

Université de Lille
Inserm
CHU Lille

Collections :

• Institut de Recherche Translationnelle sur l'Inflammation (INFINITE) - U1286

Submission date :

2025-01-01T22:05:50Z
2025-01-15T08:49:34Z