Evaluating the Prognostic Value of the MELD 3.0 Score in Predicting Mortality in Patients With Cirrhosis With Acute Variceal Bleeding.

INTRODUCTION

Acute variceal bleeding (AVB) is a severe complication of cirrhosis, with a 6-week mortality rate of up to 15%-20%. Early risk prediction is essential for guiding management. Model for End-Stage Liver Disease (MELD) 3.0, a refined version of the original MELD score, incorporates additional variables (sex, sodium, albumin, capped creatinine) to improve short-term mortality prediction. This study assessed MELD 3.0's use in predicting 6-week mortality in cirrhotic patients with AVB, in comparison with MELD, Glasgow-Blatchford Score (GBS), and Albumin, INR, Mental status, Systolic blood pressure, Age ≥ 65 (AIMS65).

METHODS

A prospective cohort of cirrhotic patients with AVB admitted to Cho Ray Hospital (November 2023-May 2024) was studied. The primary outcome was 6-week mortality; in-hospital mortality was secondary. The predictive performance of MELD 3.0, MELD, GBS, and AIMS65 was evaluated using area under the receiver operating characteristic (AUROC).

RESULTS

Among 212 patients, in-hospital and 6-week mortality rates were 4.7% and 19.8%, respectively. For in-hospital mortality, MELD 3.0 showed the highest AUROC (0.88), followed by MELD (0.80), AIMS65 (0.74), and GBS (0.59). For 6-week mortality, MELD 3.0 again outperformed others (AUROC: 0.81), vs MELD (0.75), AIMS65 (0.66), and GBS (0.61) (all P < 0.05). A MELD 3.0 cutoff ≥ 20 predicted >25% 6-week mortality (sensitivity 69.1%, specificity 83.5%).

DISCUSSION: MELD 3.0 is a strong predictor of early mortality in cirrhotic patients with AVB. A cutoff ≥20 may help identify high-risk patients requiring prompt intensive care.