Defining risk in alcohol associated liver disease using the model for end stage liver disease
Parker, Richard Aithal, Guru Allison, Michael Brahmania, Mayur Forrest, Ewan Hagström, Hannes Lee, Brian T Park, Soyoun J McCune, Anne Morgan, Timothy
Parker, Richard
Aithal, Guru
Allison, Michael
Brahmania, Mayur
Forrest, Ewan
Hagström, Hannes
Lee, Brian T
Park, Soyoun J
McCune, Anne
Morgan, Timothy
Affiliation
St James's University Hospital; University of Leeds; NIHR Nottingham Biomedical Research Center; Cambridge University Hospitals NHS Foundation Trust; University of Calgary; Glasgow Royal Infirmary; University of Glasgow; Karolinska Institutet; Karolinska University Hospital; Loma Linda University Health; Hoag Health; University Hospitals of Bristol and Weston; VA Long Beach Healthcare System; University of California; Newcastle Hospitals NHS Foundation Trust; University Hospitals Birmingham NHS Foundation Trust; University of Sydney; Sydney Local Health District; University of Sydney; Royal Prince Alfred Hospital
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Publication date
2025-07-17
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Abstract
Background: Alcohol associated liver disease (ALD) is a common cause of morbidity and premature mortality. Most prognostic scores have been defined in the short term. We used a large retrospective cohort of patients with ALD to describe the natural history of ALD and to define risk prediction in the longer term, taking non-liver mortality into account.
Methods: The WALDO cohort includes 734 patients with biopsy-proven ALD. Prognostic scores were assessed with dynamic area under the curve (AUCt) and C-index. Risk estimates for morbidity and mortality were derived for the model for end stage liver disease (MELD) and validated in an external cohort.
Results: During a median follow up of 4.9 years, 240 patients died from liver disease or underwent LT, and 114 patients died from non-liver causes. Outcomes varied across the spectrum of ALD: the cumulative incidence of liver-related death or LT in people with decompensated cirrhosis or alcohol associated hepatitis was 47% and 40% respectively, compared to 7.4% in patients without cirrhosis and 13% in compensated cirrhosis. MELD was the best predictor of outcomes: (AUCt for mortality/LT at one year was 0.853), although MELD3.0 and Child-Turcotte-Pugh score performed similarly. Risk of liver-related outcomes were tabulated for integer values of the MELD score. Risk estimates based on the MELD were well calibrated in an external cohort.
Conclusions: These data illustrate the natural history of ALD and define the risks of outcomes based on the MELD score across the spectrum of disease.
Citation
Parker R, Aithal G, Allison M, Brahmania M, Forrest E, Hagström H, Lee BT, Park SJ, McCune A, Morgan T, Naik K, Masson S, Rajoriya N, Seth D, Liu K, Chetwood J, Schaefer E, Luther J, Goodman R, Rowe I; WALDO study group. Defining risk in Alcohol associated Liver Disease using the Model for End Stage Liver Disease. Am J Gastroenterol. 2025 Jul 17. doi: 10.14309/ajg.0000000000003649. Epub ahead of print.
Type
Journal Article