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

Area of Science:

• Hepatology
• Nephrology
• Clinical Prognostics

Background:

• Hepatorenal syndrome-acute kidney injury (HRS-AKI) is a severe complication of decompensated cirrhosis.
• Existing prognostic tools like MELD, MELD-Na, and Child-Turcotte-Pugh (CTP) have limitations in predicting short-term outcomes for HRS-AKI patients.

Purpose of the Study:

• To evaluate the prognostic accuracy of the MELD 3.0 score for predicting 90-day mortality in patients diagnosed with HRS-AKI.
• To compare the performance of MELD 3.0 against established scoring systems (MELD, MELD-Na, CTP) in this specific patient cohort.

Main Methods:

• A multicentre retrospective cohort study involving 539 HRS-AKI patients from three tertiary hospitals (2015-2023).
• Comparative analysis of MELD 3.0, MELD, MELD-Na, and CTP scores using receiver operating characteristic (ROC) curves (AUC) and net reclassification improvement (NRI).

Main Results:

• MELD 3.0 demonstrated superior predictive performance for 90-day mortality (AUC=0.812), outperforming MELD (AUC=0.790), MELD-Na (AUC=0.791), and CTP (AUC=0.756).
• MELD 3.0 was an independent predictor of mortality and showed significant improvements in reclassification over other scores (NRI: 7.05% for MELD, 6.01% for MELD-Na, 13.75% for CTP).
• The predictive accuracy of MELD 3.0 remained consistent across various subgroups, including different levels of ACLF severity, age groups, and responses to treatment.

Conclusions:

• This study provides the first large-scale validation of MELD 3.0 in patients with HRS-AKI.
• MELD 3.0 offers improved discrimination and reclassification, serving as a more precise tool for early risk stratification.
• The findings suggest MELD 3.0 can guide timely interventions, inform transplant decisions, and enhance personalized care for critically ill HRS-AKI patients.