Defining Risk in Alcohol-Associated Liver Disease Using the Model for End-Stage Liver Disease

Area of Science:

• Hepatology
• Internal Medicine
• Clinical Prognostics

Background:

• Alcohol-associated liver disease (ALD) is a significant cause of illness and death.
• Existing prognostic scores for ALD often lack long-term predictive accuracy.
• Understanding the natural history and long-term risks of ALD is crucial for patient management.

Purpose of the Study:

• To describe the natural history of alcohol-associated liver disease (ALD) over the long term.
• To evaluate and define risk prediction for morbidity and mortality in ALD, including non-liver causes.
• To assess the predictive performance of prognostic scores like MELD in a large ALD cohort.

Main Methods:

• Utilized the WALDO cohort, comprising 734 patients with biopsy-proven ALD.
• Assessed prognostic scores using dynamic area under the curve and C-index.
• Derived and validated risk estimates for the Model for End-Stage Liver Disease (MELD) in an external cohort.

Main Results:

• Over a median of 4.9 years, 240 patients died from liver disease or underwent liver transplantation (LT), and 114 died from non-liver causes.
• Liver-related death or LT incidence varied significantly by ALD severity: 47% in decompensated cirrhosis, 40% in alcohol-associated hepatitis, 13% in compensated cirrhosis, and 7.4% in patients without cirrhosis.
• The Model for End-Stage Liver Disease (MELD) score demonstrated the best predictive accuracy for mortality/LT at 1 year (AUC 0.853), performing similarly to MELD3.0 and Child-Turcotte-Pugh score.

Conclusions:

• The study elucidates the natural history of alcohol-associated liver disease.
• The Model for End-Stage Liver Disease (MELD) score effectively defines risks for various outcomes across the spectrum of ALD.
• Risk stratification using MELD scores is validated and applicable for long-term prognostication in ALD patients.