Is on-treatment change of Model for End-Stage Liver Disease (MELD) score a useful prognostic marker on mortality and hepatic events in chronic hepatitis B patients with cirrhosis?—A cohort study of 1,729 subjects
Refereed conference paper presented and published in conference proceedings


摘要Background: Antiviral treatments can modify the natural history of chronic viral hepatitis. This is reflected by improving Model for EndStage Liver Disease (MELD) score over time. Whether this improvement correlates with more favorable clinical outcomes remains unclear. This study evaluated the impact of on-treatment change of MELD score in patients with chronic hepatitis B (CHB)-related cirrhosis.

Method: CHB patients with cirrhosis who were treated with entecavir (ETV) and/or tenofovir disoproxil fumarate (TDF) for at least 1 year from 2005 to 2016 were identified from a territory-wide cohort in Hong Kong. Patients with MELD scores available at baseline and one year after ETV/TDF were included. The primary and secondary outcomes were all-cause mortality and hepatic events. Patients with cancers including hepatocellular carcinoma previously or during the first year of treatment were excluded.

Result: We identified 1,729 CHB patients (71.0% male, mean age 59.8 ± 11.5 years) with cirrhosis. The mean MELD score was 11.2 ± 4.5 at baseline and 9.9 ± 3.4 at one year; 1,059 (61.2%) patients had a decreased MELD score. At a median (interquartile range) follow-up of 4.6 (2.6–6.0) years, 238 (13.8%) patients died. Among 1,191 patients without prior hepatic events including ascites, spontaneous bacterial peritonitis, variceal hemorrhage, hepatorenal syndrome, hepatic encephalopathy, and liver transplantation based on the International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes, 99 (8.3%) patients developed hepatic events; 709 (59.5%) patients achieved a decreased MELD score. The adjusted hazard ratio (95% confidence interval) for the decrease of MELD from baseline to Year 1 was 0.87 (0.85–0.89; P<0.001) for all-cause mortality and 0.89 (0.84–0.95; P<0.001) for hepatic events after adjustment of MELD score at baseline. Thus, each unit of improvement in MELD score after one year of antiviral treatment contributed to a 13% reduction in all-cause mortality and a 11% reduction in hepatic events in the next 5 years. Among 835 patients who had a MELD score C 10 at baseline, the 5-year cumulative incidence of all-cause mortality was 23.2% vs. 42.1% for patients who achieved more than 1 point decrease in MELD score at Year 1 compared with those who did not. (log-rank test, P<0.001) (Figure 1). Among 429 patients who had a MELD score <10 at baseline and without prior hepatic events, the corresponding 5-year cumulative incidence of hepatic events was 18.3% vs. 24.3%, respectively (Gray’s test, P = 0.056) (Figure 2).

Conclusion: Improvement in the MELD score after 1 year of antiviral therapy predicts all-cause mortality and hepatic events in cirrhotic CHB patients.
著者Cheuk Fung Yip, Grace Lai Hung Wong, Henry Lik Yuen Chan, Yee Kit Tse, Vincent Wai Sun Wong
會議名稱The Asian Pacific Association for the Study of the Liver (APASL) 2018 Annual Meeting
會議地點New Delhi
會議論文集題名Hepatology International
期次Suppl 2
頁次S271 - S272

上次更新時間 2019-21-10 於 15:39