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MELD-Lactate Predicts Poor Outcome in Variceal Bleeding in Cirrhosis

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An Editorial to this article was published on 14 November 2022

Abstract

Background

Predictors of poor outcome associated with variceal bleeding remain suboptimal. In patients with cirrhosis, serum lactate combined with Model for End-Stage Liver Disease (MELD-LA) improved prediction across heterogeneous populations. However, prognostic properties have not yet been assessed in the context of variceal bleeding.

Aims

We aimed to evaluate the predictive performance of MELD-LA compared to MELD, lactate, and nadir hemoglobin in cirrhosis patients with variceal bleeding.

Methods

In this multicenter study, we identified 472 patients with variceal bleeding from a German primary cohort (University Hospitals Hamburg/Frankfurt/Cologne), and two independent external validation cohorts [Veterans Affairs (VA), Baylor University]. Discrimination for 30-day mortality was analyzed and scores were compared. MELD-LA was evaluated separately in validation cohorts to ensure consistency of findings.

Results

In contrast to nadir hemoglobin, MELD and peak-lactate at time of bleeding were significantly higher in 30-day non-survivors in the primary cohort (p = 0.708; p < 0.001). MELD-LA had excellent discrimination for 30-day mortality (AUROC 0.82, 95% CI 0.76–0.88), better than MELD and peak-lactate (AUROC 0.78, 95% CI 0.71–0.84; AUROC 0.73, 95% CI 0.66–0.81). MELD-LA predicted 30-day mortality independently of age, sex, severity of liver disease and vasopressor support (HR 1.29 per 1-point-increase of MELD-LA; 95% CI 1.19–1.41; p < 0.001). Similarly, MELD-LA demonstrated excellent discrimination for 30-day mortality in the VA (AUROC = 0.86, 95% CI 0.79–0.93) and Baylor cohort (AUROC = 0.85, 95% CI 0.74–0.95).

Conclusions

MELD-LA significantly improves discrimination of short-term mortality associated with variceal bleeding, compared to MELD, peak-lactate and nadir hemoglobin. Thus, MELD-LA might represent a useful and objective marker for risk assessment and therapeutic intervention in patients with variceal bleeding.

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Abbreviations

MELD:

Model for End-Stage Liver Disease

MELD-LA:

Model for End-Stage Liver Disease-lactate score

VA:

Veterans Affairs

GI:

Gastrointestinal

CTP:

Child–Turcotte–Pugh

AUROC:

Area under the receiver operating characteristic curve

ALD:

Alcohol-related liver disease

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Acknowledgments

The authors thank Elaine Hussey for proofreading and linguistic correction of the manuscript.

Funding

This is an academic study; no specific funding has been received for conducting this study.

Author information

Authors and Affiliations

  1. I. Department of Medicine, Gastroenterology and Hepatology, University Medical Center Hamburg-Eppendorf, Martinistr. 42, 20246, Hamburg, Germany

    Thomas Horvatits, Oliver Seiz, Dominik Reher, Andreas Drolz, Sebastian Wittmann, Felix Piecha, Samuel Huber, Ansgar W. Lohse & Johannes Kluwe

  2. Division of Gastroenterology and Hepatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA

    Nadim Mahmud & Marina Serper

  3. Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA

    Nadim Mahmud & Marina Serper

  4. Baylor Scott and White, Baylor University Medical Center, Dallas, TX, USA

    Naveed Sarnast, Gerald Ogola & Sumeet K. Asrani

  5. Department of Internal Medicine I, University of Frankfurt, Frankfurt, Germany

    Wenyi Gu, Hans Peter Erasmus, Phillip Ferstl, Stefan Zeuzem & Jonel Trebicka

  6. Department of Gastroenterology and Hepatology, University Hospital Cologne, Cologne, Germany

    Gabriel Allo & Christoph Schramm

  7. Department of Interdisciplinary Endoscopy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    Stefan Groth & Thomas Rösch

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  1. Thomas Horvatits
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  2. Nadim Mahmud
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Correspondence to Thomas Horvatits.

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All authors declare that they have no conflict of interests regarding this manuscript. All authors approved the manuscript. Authors had authority over manuscript preparation and the decision to submit the manuscript for publication. The participating centers take responsibility for the integrity of the original data and data analyses contributed.

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Horvatits, T., Mahmud, N., Serper, M. et al. MELD-Lactate Predicts Poor Outcome in Variceal Bleeding in Cirrhosis. Dig Dis Sci 68, 1042–1050 (2023). https://doi.org/10.1007/s10620-022-07744-w

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