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Model for end-stage liver disease-3.0 vs. model for end-stage liver disease-sodium: mortality prediction in Korea

Jeong Han Kim1,2, Yong Joon Cho1, Won Hyeok Choe1

  • 1Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea.

The Korean Journal of Internal Medicine
|January 31, 2024
PubMed
Abstract

Insights

The updated Model for End-Stage Liver Disease 3.0 (MELD-3.0) shows improved accuracy in predicting short-term mortality for Korean liver cirrhosis patients compared to MELD-Na. This finding aids in better patient prioritization for liver transplantation.

Area of Science:

  • Hepatology
  • Medical Statistics
  • Clinical Prediction Models

Background:

  • The Model for End-Stage Liver Disease (MELD) is crucial for assessing short-term mortality in liver cirrhosis (LC) patients and prioritizing liver transplantation.
  • MELD-3.0, an updated version introduced in 2021, aims to enhance the predictive accuracy of the original MELD score.
  • Comparing MELD-3.0 with MELD-Na is essential to evaluate its improved efficacy in diverse patient populations.

Purpose of the Study:

  • To compare the predictive performance of MELD-3.0 against MELD-Na for short-term mortality in Korean patients with liver cirrhosis.
  • To assess the accuracy of both MELD scores in predicting 3-month and 6-month mortality rates.

Main Methods:

  • A retrospective analysis of 3,034 liver cirrhosis patients admitted to Konkuk University Hospital between 2011 and 2021.
  • Calculation of MELD-Na and MELD-3.0 scores for all patients.
  • Utilized the area under the receiver operating curve (AUROC) to evaluate predictive values for 3- and 6-month mortality, with the DeLong test for statistical comparison.

Main Results:

  • A total of 339 (11.2%) and 421 (14.4%) patients died within 3 and 6 months, respectively.
  • MELD-3.0 demonstrated superior predictive ability over MELD-Na for both 3-month (AUROC 0.851 vs. 0.846) and 6-month mortality (AUROC 0.848 vs. 0.843).
  • The differences in AUROC values were statistically significant for both 3-month (p=0.03) and 6-month mortality (p=0.01).

Conclusions:

  • MELD-3.0 shows a statistically significant improvement in predicting mortality for Korean liver cirrhosis patients compared to MELD-Na.
  • The findings support the enhanced utility of MELD-3.0 in clinical practice for managing liver cirrhosis and guiding transplantation decisions.
Keywords:
CreatinineEnd stage liver diseaseLiver cirrhosisMortalitySodium

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