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MELD and MELD-Na demonstrate higher specificity than Maddrey discriminant function for alcoholic hepatitis mortalityNew data compares scoring tools for alcoholic hepatitis mortality

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Key Takeaway
Note that MELD and MELD-Na scores provide higher specificity than Maddrey's discriminant function for predicting mortality.

This systematic review and diagnostic meta-analysis evaluated the accuracy of three scoring systems—Maddrey's discriminant function (MDF), Model for End-Stage Liver Disease (MELD), and modified MELD including sodium (MELD-Na)—in predicting mortality for patients with alcoholic hepatitis. The analysis focused on sensitivity, specificity, and area under the curve (AUC) at 28 days and 90 days.

Results indicated that MDF had a sensitivity of 0.898 at both 28 and 90 days, while MELD showed sensitivities of 0.862 and 0.884, respectively. However, MELD demonstrated higher specificity than MDF (0.697 at 28 days and 0.557 at 90 days compared to 0.370 and 0.346 for MDF). MELD-Na showed a sensitivity of 0.652 at 28 days and 0.701 at 90 days, with specificity values of 0.757 and 0.816, respectively.

No significant statistical difference was observed when comparing the area under the curve (AUC) for these scores. While all models provide some predictive value, the higher specificity of MELD and MELD-Na may offer more precise identification of high-risk patients compared to the MDF score. Clinical application should consider these differences in specificity when managing alcoholic hepatitis mortality risk.

When a patient is diagnosed with alcoholic hepatitis, doctors must act quickly. They often use specific scoring systems to predict how well a patient might survive the next few weeks or months. These scores help medical teams prioritize care and manage treatment plans for people with severe liver disease.

A large review compared three common tools: Maddrey's discriminant function (MDF), MELD, and MELD-Na. Each tool looks at different factors to predict mortality at 28 days and 90 days. While the scores showed different levels of sensitivity and specificity across the board, the study found no significant statistical difference when comparing the overall accuracy of these three methods.

Because the tools performed similarly in terms of overall area under the curve, it suggests that while each method has its own way of calculating risk, they provide comparable predictive power. This information helps doctors understand which tools are available for assessing patient outcomes in liver disease.

What this means for you:
Three different scoring systems show no significant difference in their overall accuracy for predicting mortality.

Common questions

What are the different ways doctors measure risk in alcoholic hepatitis?

Doctors use three main scoring systems: Maddrey's discriminant function (MDF), MELD, and MELD-Na. These tools help predict mortality at 28 days and 90 days for patients with alcoholic hepatitis.

Are some scores more accurate than others for predicting survival?

The study found no significant statistical difference when comparing the area under the curve for MDF, MELD, and MELD-Na. This means all three tools showed similar overall accuracy in predicting outcomes.

Study Details

Study typeMeta analysis
EvidenceLevel 1
PublishedJul 2026
View Original Abstract ↓
Alcoholic hepatitis is a form of acute liver injury with significant morbidity and mortality. Several scoring systems have been developed and used to predict mortality, including Maddrey's discriminant function (MDF), model for end-stage liver disease (MELD), and modified MELD including sodium (MELD-Na). We conducted a systematic review of Pubmed, Embase, and Cochrane Library to compare the accuracy of these scores in alcoholic hepatitis mortality prediction. The pooled sensitivity and specificity of MDF for mortality prediction in 28 days were 0.898 [95% confidence interval (CI) 0.777-0.957, I2  = 0%] and 0.370 (95% CI: 0.271-0.482, I2 = 78%), respectively; in 90 days, they were 0.898 (95% CI: 0.799-0.951, I2 =21%) and 0.346 (95% CI: 0.246-0.463, I2 = 88%), respectively. The pooled sensitivity and specificity of MELD for mortality prediction in 28 days were 0.862 (95% CI: 0.755-0.926, I2 = 0%) and 0.697 (95% CI: 0.552-0.812, I2 = 82%), respectively; in 90 days, they were 0.884 (95% CI: 0.802-0.935, I2 = 21%) and 0.557 (95% CI: 0.300-0.787, I2 = 96%), respectively. The pooled sensitivity and specificity of MELD-Na for mortality prediction in 28 days were 0.652 (95% CI: 0.429-0.823, I2 = 79%) and 0.757 (95% CI: 0.666-0.830, I2 = 91%), respectively; in 90 days, they were 0.701 (95% CI: 0.661-0.737, I2 = 53%) and 0.816 (95% CI: 0.711-0.888, I2 = 94%), respectively. No significant statistical difference was observed when comparing area under the curve of these scores.
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