MELD 3.0 Improves Risk Stratification and Mortality Prediction in Hepatorenal Syndrome-Acute Kidney Injury: A...

Hepatorenal syndrome-acute kidney injury (HRS-AKI) is a life-threatening complication in decompensated cirrhosis with limited predictive tools for short-term prognosis. Traditional models such as MELD, MELD-Na and Child-Turcotte-Pugh (CTP) have notable limitations in this population.

This study aimed to evaluate the prognostic performance of the newly developed MELD 3.0 score in predicting 90-day mortality among patients with HRS-AKI.

In this multicentre retrospective cohort study, 539 patients with HRS-AKI were enrolled from three tertiary hospitals between 2015 and 2023. The predictive performance of MELD 3.0 for 90-day mortality was systematically compared with MELD, MELD-Na, and CTP scores through ROC curve (AUC) and net reclassification improvement (NRI) analysis.

MELD 3.0 demonstrated the highest predictive performance for 90-day mortality (AUC = 0.812), significantly surpassing MELD (AUC = 0.790, p = 0.006), MELD-Na (AUC = 0.791, p = 0.002) and CTP (AUC = 0.756, p = 0.005). It was an independent predictor of mortality (HR = 1.13 per point, 95% CI: 1.11-1.16, p < 0.001) and achieved significant NRI over MELD (7.05%), MELD-Na (6.01%) and CTP (13.75%). Its predictive performance remained robust across ACLF severity, age subgroups and treatment response profiles.

This is the first large-scale study to validate MELD 3.0 in HRS-AKI. By offering enhanced discrimination and clinically meaningful reclassification, MELD 3.0 provides a more refined tool for early risk stratification, with potential to guide timely intervention, inform transplant decisions and improve personalized care in this critically ill population.