A model for end stage liver disease (MELD) score over 30 was proposed as a predictor of mortality in patients with non-acetaminophen-induced acute liver failure.
Dr Frederik Nevens and colleagues from Belgium analyzed the prognostic value of MELD score in patients with acute liver failure.
There were 106 patients who were prospectively registered in a database since 1990, and who met the criteria.
The research team excluded 7 patients with acetaminophen etiology.
The team identified cryptogenic causes in 38 patients, viral in 29, drugs in 20, and miscellaneous causes in 12.
Of these, 37% survived with medical management alone, 16% died, and 46% underwent liver transplantation.
|A MELD score over 35 had a sensitivity of 86%|
The strongest predictors of poor outcome were advanced encephalopathy, and cryptogenic, drug-induced, or Hepatitis B etiology.
The researchers noted that a high MELD score was also a strong predictor of poor outcome.
At the time of diagnosis, King's College Hospital criteria and a MELD score over 30 had similar high negative predictive values.
The negative predictive value of the King's College Hospital criteria and a MELD score over 30 was 92% and 91%, respectively.
The team found that positive predictive value using King's College Hospital criteria was 52%.
The research team noted that the positive predictive value of a MELD score over 30 was 56%.
The team observed that the predictive values improved only slightly during follow-up.
The best cut-off point for MELD score to discriminate between survivors and nonsurvivors was over 35.
The researchers found that the sensitivity and specificity of this discriminative test was 86% and 75%, respectively.
Dr Nevens' team concludes, “MELD score has a similar prognostic value as King's College Hospital criteria to predict outcome in adult patients with nonacetaminophen-induced acute liver failure.”
“Overall, all current scores miss accuracy.”
“There is a clear need for factors that can better predict the regeneration of the liver in this setting.”