Background & aims: Although the discriminative ability of the model for end-stage liver disease (MELD) score is generally considered acceptable, its calibration is still unclear. In a validation study, we assessed the discriminative performance and calibration of 3 versions of the model: original MELD-TIPS, used to predict survival after transjugular intrahepatic portosystemic shunt (TIPS); classic MELD-Mayo; and MELD-UNOS, used by the United Network for Organ Sharing (UNOS). We also explored recalibrating and updating the model. Methods: In total, 776 patients who underwent elective TIPS (TIPS cohort) and 445 unselected patients (non-TIPS cohort) were included. Three, 6 and 12-month mortality predictions were calculated by the 3 MELD versions: discrimination was assessed by c-statistics and calibration by comparing deciles of predicted and observed risks. Cox and Fine and Grey models were used for recalibration and prognostic analyses. Results: In the TIPS/non-TIPS cohorts, the etiology of liver disease was viral in 402/188, alcoholic in 185/130, and non-alcoholic steatohepatitis in 65/33; mean follow-up±SD was 25±9/19±21 months; and the number of deaths at 3-6-12 months was 57-102-142/31-47-99, respectively. C-statistics ranged from 0.66 to 0.72 in TIPS and 0.66 to 0.76 in non-TIPS cohorts across prediction times and scores. A post hoc analysis revealed worse c-statistics in non-viral cirrhosis with more pronounced and significant worsening in the non-TIPS cohort. Calibration was acceptable with MELD-TIPS but largely unsatisfactory with MELD-Mayo and -UNOS whose performance improved much after recalibration. A prognostic analysis showed that age, albumin, and TIPS indication might be used to update the MELD. Conclusions: In this validation study, the performance of the MELD score was largely unsatisfactory, particularly in non-viral cirrhosis. MELD recalibration and candidate variables for an update to the MELD score are proposed. Lay summary: While the discriminative performance of the model for end-stage liver disease (MELD) score is credited to be fair to good, its calibration, the correspondence of observed to predicted mortality, is still unsettled. We found that application of 3 different versions of the MELD in 2 independent cirrhosis cohorts yielded largely imprecise mortality predictions particularly in non-viral cirrhosis. Thus, we propose a recalibration and suggest candidate variables for an update to the model.

Performance of the model for end-stage liver disease score for mortality prediction and the potential role of etiology / D'Amico, Gennaro; Maruzzelli, Luigi; Airoldi, Aldo; Petridis, Ioannis; Tosetti, Giulia; Rampoldi, Antonio; D'Amico, Mario; Miraglia, Roberto; De Nicola, Stella; La Mura, Vincenzo; Solcia, Marco; Volpes, Riccardo; Perricone, Giovanni; Sgrazzutti, Cristiano; Vanzulli, Angelo; Primignani, Massimo; D'Angelo, Luca; Malizia, Giuseppe; Federico, Alessandro; Dallio, Marcello; Andriulli, Angelo; Iacobellis, Angelo; Addario, Luigi; Garcovich, Matteo; Gasbarrini, Antonio; Chessa, Luchino; Salerno, Francesco; Gobbo, Giulia; Merli, Manuela; Ridola, Lorenzo; Baroni, Gianluca Svegliati; Tarantino, Giuseppe; Caporaso, Nicola; Morisco, Filomena; Pozzoni, Pietro; Colli, Agostino; Belli, Luca Saverio. - In: JOURNAL OF HEPATOLOGY. - ISSN 0168-8278. - 75:6(2021), pp. 1355-1366. [10.1016/j.jhep.2021.07.018]

Performance of the model for end-stage liver disease score for mortality prediction and the potential role of etiology

D'Amico, Mario;Luca, Angelo;Dallio, Marcello;Caporaso, Nicola;Morisco, Filomena;
2021

Abstract

Background & aims: Although the discriminative ability of the model for end-stage liver disease (MELD) score is generally considered acceptable, its calibration is still unclear. In a validation study, we assessed the discriminative performance and calibration of 3 versions of the model: original MELD-TIPS, used to predict survival after transjugular intrahepatic portosystemic shunt (TIPS); classic MELD-Mayo; and MELD-UNOS, used by the United Network for Organ Sharing (UNOS). We also explored recalibrating and updating the model. Methods: In total, 776 patients who underwent elective TIPS (TIPS cohort) and 445 unselected patients (non-TIPS cohort) were included. Three, 6 and 12-month mortality predictions were calculated by the 3 MELD versions: discrimination was assessed by c-statistics and calibration by comparing deciles of predicted and observed risks. Cox and Fine and Grey models were used for recalibration and prognostic analyses. Results: In the TIPS/non-TIPS cohorts, the etiology of liver disease was viral in 402/188, alcoholic in 185/130, and non-alcoholic steatohepatitis in 65/33; mean follow-up±SD was 25±9/19±21 months; and the number of deaths at 3-6-12 months was 57-102-142/31-47-99, respectively. C-statistics ranged from 0.66 to 0.72 in TIPS and 0.66 to 0.76 in non-TIPS cohorts across prediction times and scores. A post hoc analysis revealed worse c-statistics in non-viral cirrhosis with more pronounced and significant worsening in the non-TIPS cohort. Calibration was acceptable with MELD-TIPS but largely unsatisfactory with MELD-Mayo and -UNOS whose performance improved much after recalibration. A prognostic analysis showed that age, albumin, and TIPS indication might be used to update the MELD. Conclusions: In this validation study, the performance of the MELD score was largely unsatisfactory, particularly in non-viral cirrhosis. MELD recalibration and candidate variables for an update to the MELD score are proposed. Lay summary: While the discriminative performance of the model for end-stage liver disease (MELD) score is credited to be fair to good, its calibration, the correspondence of observed to predicted mortality, is still unsettled. We found that application of 3 different versions of the MELD in 2 independent cirrhosis cohorts yielded largely imprecise mortality predictions particularly in non-viral cirrhosis. Thus, we propose a recalibration and suggest candidate variables for an update to the model.
2021
Performance of the model for end-stage liver disease score for mortality prediction and the potential role of etiology / D'Amico, Gennaro; Maruzzelli, Luigi; Airoldi, Aldo; Petridis, Ioannis; Tosetti, Giulia; Rampoldi, Antonio; D'Amico, Mario; Miraglia, Roberto; De Nicola, Stella; La Mura, Vincenzo; Solcia, Marco; Volpes, Riccardo; Perricone, Giovanni; Sgrazzutti, Cristiano; Vanzulli, Angelo; Primignani, Massimo; D'Angelo, Luca; Malizia, Giuseppe; Federico, Alessandro; Dallio, Marcello; Andriulli, Angelo; Iacobellis, Angelo; Addario, Luigi; Garcovich, Matteo; Gasbarrini, Antonio; Chessa, Luchino; Salerno, Francesco; Gobbo, Giulia; Merli, Manuela; Ridola, Lorenzo; Baroni, Gianluca Svegliati; Tarantino, Giuseppe; Caporaso, Nicola; Morisco, Filomena; Pozzoni, Pietro; Colli, Agostino; Belli, Luca Saverio. - In: JOURNAL OF HEPATOLOGY. - ISSN 0168-8278. - 75:6(2021), pp. 1355-1366. [10.1016/j.jhep.2021.07.018]
File in questo prodotto:
Non ci sono file associati a questo prodotto.

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11588/906380
Citazioni
  • ???jsp.display-item.citation.pmc??? ND
  • Scopus 18
  • ???jsp.display-item.citation.isi??? 14
social impact