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MELD score change during HBV therapy reduces mortality risk

On-treatment improvement of MELD scores correlated with reduced risk for all-cause mortality and hepatic events among patients with chronic hepatitis B and cirrhosis, according to a recently published study.

According to Terry Cheuk-Fung Yip, MPhil, from the Chinese University of Hong Kong, and colleagues, an increase in MELD score correlated with new cirrhotic complications and mortality, whereas nucleos(t)ide analogues therapy for chronic HBV led to an improved MELD score.

“MELD score is currently the prevailing criteria for prioritizing patients with end-stage liver disease for liver transplantation,” Yip and colleagues wrote. “On-treatment change of MELD score captures the dynamic change of liver function during antiviral treatment. It reflects the on-treatment modification of natural history of [chronic HBV (CHB)] and the improvement on virological, biochemical, and histological parameters of patients with CHB-related cirrhosis.”

To evaluate the impact of on-treatment change of MELD score on mortality, hepatocellular carcinoma, and hepatic events in patients with CHB-related cirrhosis, Yip and colleagues enrolled 1,743 patients who underwent treatment with entecavir or tenofovir disoproxil fumarate for at least 6 months.

At follow-up, 290 patients died, 201 developed HCC, and 150 patients without a history of hepatic events experienced at least one event.

Mean MELD score decreased from 12.3 at baseline to 11 after 6 months of therapy (P < .001). Serum total bilirubin demonstrated the largest improvement among MELD score components with a mean decrease from 2.4 mg/dL to 1.5 mg/dL (P < .001).

Compared with patients whose score remained at 15 or higher, patients with a MELD score less than 15 at 6 months had a lower risk for mortality (63.8% vs. 21.3%; P < .001) and hepatic events (47.6% vs. 23.2%; P < .001).

Among patients with a baseline MELD score of 15 or higher, decreased MELD score at 6 months correlated with a lower risk for all-cause mortality (HR = 0.86; 95% CI, 0.83-0.89) but did not affect the risk for HCC.

Patients with a MELD score less than 15 at 6 months were younger, more likely to have positive HBV e-antigen, lower serum creatinine, and higher platelet counts, serum albumin, total bilirubin, serum HBV DNA, and alanine aminotransferase levels at baseline than patients with a MELD score of 15 or higher at 6 months.

“Our findings showed that patients with MELD score [less than] 15 after 6-month of treatment are associated with reduced risk of all-cause mortality and hepatic events in the next 5.5 years,” Yip and colleagues wrote. “This agrees with the recommendation of using 15 as cut-off of MELD score for the allocation of liver transplantation.” – by Talitha Bennett

Disclosure: Yip reports no relevant financial disclosures. Please see the full study for the other authors’ relevant financial disclosures.