The Predictive Role of Model for End-Stage Liver Disease–Lactate and Lactate Clearance for In-Hospital Mortality Among a National Cirrhosis Cohort

Nadim Mahmud, Sumeet K. Asrani, David E. Kaplan, Gerald O. Ogola, Tamar H. Taddei, Patrick S. Kamath, Marina Serper

Research output: Contribution to journalArticlepeer-review

Abstract

The burden of cirrhosis hospitalizations is increasing. The admission Model for End-Stage Liver Disease–lactate (MELD-lactate) was recently demonstrated to be a superior predictor of in-hospital mortality compared with MELD in limited cohorts. We identified specific classes of hospitalizations where MELD-lactate may be especially useful and evaluated the predictive role of lactate clearance. This was a retrospective cohort study of 1036 cirrhosis hospitalizations for gastrointestinal bleeding, infection, or other portal hypertension–related indications in the Veterans Health Administration where MELD-lactate was measured on admission. Performance characteristics for in-hospital mortality were compared between MELD-lactate and MELD/MELD-sodium (MELD-Na), with stratified analyses of MELD categories (≤15, >15 to <25, ≥25) and reason for admission. We also incorporated day 3 lactate levels into modeling and tested for an interaction between day 1 MELD-lactate and day 3 lactate clearance. MELD-lactate had superior discrimination for in-hospital mortality compared with MELD or MELD-Na (area under the curve [AUC] 0.789 versus 0.776 versus 0.760, respectively; P < 0.001) and superior calibration. MELD-lactate had higher discrimination among hospitalizations with MELD ≤15 (AUC 0.763 versus 0.608 for MELD, global P = 0.01) and hospitalizations for infection (AUC 0.791 versus 0.674 for MELD, global P < 0.001). We found a significant interaction between day 1 MELD-lactate and day 3 lactate clearance; heat maps were created as clinical tools to risk-stratify patients based on these clinical data. MELD-lactate had significantly superior performance in predicting in-hospital mortality among patients hospitalized for infection and/or with MELD ≤15 when compared with MELD or MELD-Na. Incorporating day 3 lactate clearance may further improve prognostication.

Original languageEnglish (US)
Pages (from-to)177-189
Number of pages13
JournalLiver Transplantation
Volume27
Issue number2
DOIs
StatePublished - Feb 2021

ASJC Scopus subject areas

  • Surgery
  • Hepatology
  • Transplantation

Fingerprint Dive into the research topics of 'The Predictive Role of Model for End-Stage Liver Disease–Lactate and Lactate Clearance for In-Hospital Mortality Among a National Cirrhosis Cohort'. Together they form a unique fingerprint.

Cite this