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Hepatology. 2019 Dec 23. doi: 10.1002/hep.31086. [Epub ahead of print]
Model for End-stage Liver Disease with additional criteria to predict short-term mortality in severe flares of chronic hepatitis B.
Fung J1,2,3, Mak LY1, Chan AC2,3,4, Chok KS2,3,4, Wong TC2,4, Cheung TT2,3,4, Dai WC2,4, Sin SL2,4, She WH2,4, Ma KW2,4, Seto WK1,3, Lai CL1,3, Lo CM2,3,4, Yuen MF1,3.
Author information
1
Department of Medicine, The University of Hong Kong, Hong Kong.
2
The Liver Transplant Center, Queen Mary Hospital, Hong Kong.
3
State Key Laboratory of Liver Research, The University of Hong Kong, Hong Kong.
4
Department of Surgery, The University of Hong Kong, Hong Kong.
Abstract
BACKGROUND & AIMS:
The prognosis in severe acute flares of chronic hepatitis B (AFOCHB) is often unclear. The current study aimed to establish the predictive value using the MELD score for short-term mortality for severe AFOCHB.
APPROACH & RESULTS:
Patients with severe AFOCHB with bilirubin >50 umol/l, ALT >10x upper limit of normal, and INR >1.5 were included. All patients were commenced on entecavir and/or tenofovir. Laboratory results and MELD scores were pooled to calculate mortality at four time points (day 7, 14, 21, and 28). A total of 240 patients were included. Median HBV DNA was 7.77 log IU/mL (range, 4.11-10.06), and 49 (20.4%) were HBeAg-positive. The 7, 14, 21, and 28-day survival was 96.7%, 88.5%, 79.5%, and 72.8% respectively. Using pooled results derived from 4,201 blood samples, the AUROC for the MELD score to predict day 7, 14, 21, and 28 mortality was 0.909, 0.892, 0.883, and 0.871 respectively. For MELD ≤28, mortality at day 28 was low (<25%), compared to >50% mortality for MELD ≥32. For MELD 28 to 32, higher day-28 mortality was observed for 4 criteria: age ≥52 years, ALT >217 U/L, platelets <127, and abnormal baseline imaging (all p<0.001). In this MELD bracket, the 28-day mortality was 0%, 12.1%, 23.8%, 59.4%, and 78.8% for the presence of 0, 1, 2, 3, and 4 criteria respectively.
CONCLUSIONS:
MELD score at any time points can accurately predict the short-term mortality. Patients with MELD ≥28 should be worked up for liver transplantation, and those with MELD 28-32 with 3-4 at-risk criteria, or MELD ≥32 should be listed.
© 2019 by the American Association for the Study of Liver Diseases.
KEYWORDS:
MELD; acute flare; decompensation; liver failure; liver transplantation
PMID:
31872444
DOI:
10.1002/hep.31086 |
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