Utility of the MELD and MELD-Lactate scale in patients with severe Alcoholic Hepatitis as a predictor of severity and early mortality.

Abstract

Introduction and Objectives: Alcoholic Hepatitis (AH) causes acute inflammation of the liver. The prognosis depends on the recovery of the liver from rapid improvement to multi-organ failure and death. There are scales that establish the prognosis and respond to steroid in AH, based on biochemical markers, none uses lactate levels. The lactate level in a patient with hepatitis may be increased. To determine if the MELD-Lactate scale is better than MELD for predicting with greater accuracy the severity and early mortality in patients with Alcoholic Hepatitis. Materials and Patients: Retrospective, retrollective and analytical study, from 2019 to 2022. The variables were obtained with laboratories upon admission, including lactate levels. The area under the curve for sensitivity and specificity was calculated for predictive scales and MELD-lactate to determine mortality at 28 and 90 days. Results: Include 70 patients, 59 men (84.2%) and 11 women (15.7%), age 43.2 ±9.8 years. The mortality at 28 days was 19 patients (27.1%) and at 90 days it was 18 patients (25.7%), a total of 37 (52%). The area under the curve for MELD-Lactate was in general mortality 0.823; 0.705-0.941 (sensibility 81.8% specificity 72.4%), at 28 days 0.874; 0.780-0.968 (sensibility 88.9%; specificity 71.3%) and 90 days there was no significance, compared with MELD which was general mortality 0.741; 0.603-0.878 (sensibility 81.8% specificity 66.1%), at 28 days MELD 0.766; 0.615-.916 (sensibility 88.9% specificity 63.3%) and at 90 days there was no significance, with the rest of the scales (MELD 3.0, ABIC, Maddrey, MELD- Na and Glasgow, it was less than that of MELD-Lactate. (Figure 1,2). Conclusions: Patients with severe AH have higher mortality, either early or late. In our study we showed that the MELD-lactate scale may be a better prognostic scale for early mortality in patients with alcohol hepatitis, since it showed a better performance than all the other scales used, although these results must be confirmed in other hospital centers, we can recommend their use.