Comparison of Mortality Prediction Between the Model for End-Stage Liver Disease-3.0 (MELD-3.0) and the Model for End-Stage Liver Disease-Lactate (MELD-La) in Korean Patients with Liver Cirrhosis.

Abstract

Background and Objectives: The Model for End-Stage Liver Disease (MELD) score has widely been used for mortality prediction in liver cirrhosis (LC) patients and transplantation allocation. There have been recent modifications of MELD scores, such as MELD-Lactate (MELD-La) and MELD-3.0. The goal of this study was to compare MELD, MELD-La, and MELD-3.0 in predicting mortality among LC patients in Korea. Materials and Methods: This is a retrospective, single-centered study in which LC patients admitted to Konkuk University Hospital between January 2011 and December 2022 were enrolled and reviewed. Predictive values for 1- and 3-month mortality for MELD, MELD-La, and MELD-3.0 were calculated using the area under the receiver operating characteristic (AUROC) curve. Differences between AUROCs were statistically analyzed using DeLong's test. Results: A total of 1152 patients were initially included in this study. Among them, 165 (14.3%) patients died within one month, and 211 (19.7%) died within three months. The AUROCs for 1-month mortality of MELD, MELD-La, and MELD-3.0 were 0.808, 0.79, and 0.807, respectively. For the 3-month mortality of MELD, MELD-La, and MELD-3.0, the AUROCs were 0.805, 0.753, and 0.817, respectively. Multiple comparisons of ROC curves demonstrated that MELD and MELD-3.0 reflected the 3-month mortality prediction of LC patients better than MELD-La (p = 0.0018, p = 0.0003, respectively). Conclusions: This study demonstrated that MELD and MELD-3.0 outperformed MELD-La in predicting the 3-month mortality for LC patients. However, there was no significant difference between MELD and MELD-3.0 in predicting LC patient mortality.