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MELD-Lactate Predicts Poor Outcome in Variceal Bleeding in Cirrhosis

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MELD-Lactate Predicts Poor Outcome in Variceal Bleeding in Cirrhosis. / Horvatits, Thomas; Mahmud, Nadim; Serper, Marina; Seiz, Oliver; Reher, Dominik; Drolz, Andreas; Sarnast, Naveed; Gu, Wenyi; Erasmus, Hans Peter; Allo, Gabriel; Ferstl, Phillip; Wittmann, Sebastian; Piecha, Felix; Groth, Stefan; Zeuzem, Stefan; Schramm, Christoph; Huber, Samuel; Rösch, Thomas; Lohse, Ansgar W; Trebicka, Jonel; Ogola, Gerald; Asrani, Sumeet K; Kluwe, Johannes.

In: DIGEST DIS SCI, Vol. 68, No. 3, 03.2023, p. 1042-1050.

Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review

Harvard

Horvatits, T, Mahmud, N, Serper, M, Seiz, O, Reher, D, Drolz, A, Sarnast, N, Gu, W, Erasmus, HP, Allo, G, Ferstl, P, Wittmann, S, Piecha, F, Groth, S, Zeuzem, S, Schramm, C, Huber, S, Rösch, T, Lohse, AW, Trebicka, J, Ogola, G, Asrani, SK & Kluwe, J 2023, 'MELD-Lactate Predicts Poor Outcome in Variceal Bleeding in Cirrhosis', DIGEST DIS SCI, vol. 68, no. 3, pp. 1042-1050. https://doi.org/10.1007/s10620-022-07744-w

APA

Horvatits, T., Mahmud, N., Serper, M., Seiz, O., Reher, D., Drolz, A., Sarnast, N., Gu, W., Erasmus, H. P., Allo, G., Ferstl, P., Wittmann, S., Piecha, F., Groth, S., Zeuzem, S., Schramm, C., Huber, S., Rösch, T., Lohse, A. W., ... Kluwe, J. (2023). MELD-Lactate Predicts Poor Outcome in Variceal Bleeding in Cirrhosis. DIGEST DIS SCI, 68(3), 1042-1050. https://doi.org/10.1007/s10620-022-07744-w

Vancouver

Horvatits T, Mahmud N, Serper M, Seiz O, Reher D, Drolz A et al. MELD-Lactate Predicts Poor Outcome in Variceal Bleeding in Cirrhosis. DIGEST DIS SCI. 2023 Mar;68(3):1042-1050. https://doi.org/10.1007/s10620-022-07744-w

Bibtex

@article{20c4d5ebe80f40aaae853f319029eb90,
title = "MELD-Lactate Predicts Poor Outcome in Variceal Bleeding in Cirrhosis",
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.",
author = "Thomas Horvatits and Nadim Mahmud and Marina Serper and Oliver Seiz and Dominik Reher and Andreas Drolz and Naveed Sarnast and Wenyi Gu and Erasmus, {Hans Peter} and Gabriel Allo and Phillip Ferstl and Sebastian Wittmann and Felix Piecha and Stefan Groth and Stefan Zeuzem and Christoph Schramm and Samuel Huber and Thomas R{\"o}sch and Lohse, {Ansgar W} and Jonel Trebicka and Gerald Ogola and Asrani, {Sumeet K} and Johannes Kluwe",
note = "{\textcopyright} 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.",
year = "2023",
month = mar,
doi = "10.1007/s10620-022-07744-w",
language = "English",
volume = "68",
pages = "1042--1050",
journal = "DIGEST DIS SCI",
issn = "0163-2116",
publisher = "Springer New York",
number = "3",

}

RIS

TY - JOUR

T1 - MELD-Lactate Predicts Poor Outcome in Variceal Bleeding in Cirrhosis

AU - Horvatits, Thomas

AU - Mahmud, Nadim

AU - Serper, Marina

AU - Seiz, Oliver

AU - Reher, Dominik

AU - Drolz, Andreas

AU - Sarnast, Naveed

AU - Gu, Wenyi

AU - Erasmus, Hans Peter

AU - Allo, Gabriel

AU - Ferstl, Phillip

AU - Wittmann, Sebastian

AU - Piecha, Felix

AU - Groth, Stefan

AU - Zeuzem, Stefan

AU - Schramm, Christoph

AU - Huber, Samuel

AU - Rösch, Thomas

AU - Lohse, Ansgar W

AU - Trebicka, Jonel

AU - Ogola, Gerald

AU - Asrani, Sumeet K

AU - Kluwe, Johannes

N1 - © 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

PY - 2023/3

Y1 - 2023/3

N2 - 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.

AB - 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.

U2 - 10.1007/s10620-022-07744-w

DO - 10.1007/s10620-022-07744-w

M3 - SCORING: Journal article

C2 - 36376577

VL - 68

SP - 1042

EP - 1050

JO - DIGEST DIS SCI

JF - DIGEST DIS SCI

SN - 0163-2116

IS - 3

ER -