ArticleDigestive diseases and sciences2023
MELD-Lactate Predicts Poor Outcome in Variceal Bleeding in Cirrhosis.
Article in Digestive diseases and sciences, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.
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9 citing papers in PubMed, 18 citations in OpenAlex.
- α-AMA induced liver failure is associated with elevation of HMGB1 lactylation modification in mice.BMC gastroenterology · 2026Article
- Predictive value of liver fibrosis markers and model for end-stage liver disease score in evaluating the degree of esophageal and gastric varices in cirrhosis.American journal of translational research · 2026Article
- Is There a Role for the Neutrophil-to-Lymphocyte Ratio for Rebleeding and Mortality Risk Prediction in Acute Variceal Bleeding? A Comparative 5-Year Retrospective Study.Diseases (Basel, Switzerland) · 2025Article
- Comparison of Mortality Prediction Between the Model for End-Stage Liver Disease-3.0 (MELD-3.0) and the Model for End-Stage Liver Disease-Lactate (MELD-La) in Korean Patients with Liver Cirrhosis.Medicina (Kaunas, Lithuania) · 2025Article
- The Development and Appraisal of MELD 3.0 in Liver Diseases: Good Things Never Come Easy.Journal of clinical and translational hepatology · 2025Review
- Article
- Learning curve of achieving competency in emergency endoscopy in upper gastrointestinal bleeding: how much experience is necessary?BMJ open gastroenterology · 2024Article
- Comparison of Lactate Clearance with Established Risk Assessment Tools in Predicting Outcomes in Acute Upper Gastrointestinal Bleeding.Journal of clinical medicine · 2023Article
- Pathophysiology and management of liver cirrhosis: from portal hypertension to acute-on-chronic liver failure.Frontiers in medicine · 2023Review
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23 authors at 5 institutions in 2 countries.
Funding
Abstract
backgroundPredictors of poor outcome associated with variceal bleeding remain suboptimal. In patients with cirrhosis, serum lactate combined with Model for End-Stage Liver Disease (MELD-LA) improved prediction across heterogeneous populations. However, prognostic properties have not yet been assessed in the context of variceal bleeding.
aimsWe aimed to evaluate the predictive performance of MELD-LA compared to MELD, lactate, and nadir hemoglobin in cirrhosis patients with variceal bleeding.
methodsIn this multicenter study, we identified 472 patients with variceal bleeding from a German primary cohort (University Hospitals Hamburg/Frankfurt/Cologne), and two independent external validation cohorts [Veterans Affairs (VA), Baylor University]. Discrimination for 30-day mortality was analyzed and scores were compared. MELD-LA was evaluated separately in validation cohorts to ensure consistency of findings.
resultsIn contrast to nadir hemoglobin, MELD and peak-lactate at time of bleeding were significantly higher in 30-day non-survivors in the primary cohort (p = 0.708; p < 0.001). MELD-LA had excellent discrimination for 30-day mortality (AUROC 0.82, 95% CI 0.76-0.88), better than MELD and peak-lactate (AUROC 0.78, 95% CI 0.71-0.84; AUROC 0.73, 95% CI 0.66-0.81). MELD-LA predicted 30-day mortality independently of age, sex, severity of liver disease and vasopressor support (HR 1.29 per 1-point-increase of MELD-LA; 95% CI 1.19-1.41; p < 0.001). Similarly, MELD-LA demonstrated excellent discrimination for 30-day mortality in the VA (AUROC = 0.86, 95% CI 0.79-0.93) and Baylor cohort (AUROC = 0.85, 95% CI 0.74-0.95).
conclusionsMELD-LA significantly improves discrimination of short-term mortality associated with variceal bleeding, compared to MELD, peak-lactate and nadir hemoglobin. Thus, MELD-LA might represent a useful and objective marker for risk assessment and therapeutic intervention in patients with variceal bleeding.
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