{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T04:32:17Z","timestamp":1785472337249,"version":"3.56.0"},"reference-count":39,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","license":[{"start":{"date-parts":[[2020,11,6]],"date-time":"2020-11-06T00:00:00Z","timestamp":1604620800000},"content-version":"vor","delay-in-days":5,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2020,11,1]],"date-time":"2020-11-01T00:00:00Z","timestamp":1604188800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Hepatology"],"published-print":{"date-parts":[[2020,11]]},"abstract":"<jats:sec>\n            <jats:title>Background and Aims<\/jats:title>\n            <jats:p>Compared to other chronic diseases, patients with chronic liver disease (CLD) have significantly higher inpatient mortality; accurate models to predict inpatient mortality are lacking. Serum lactate (LA) may be elevated in patients with CLD due to both tissue hypoperfusion as well as decreased LA clearance. We hypothesized that a parsimonious model consisting of Model for End\u2010Stage Liver Disease (MELD) and LA at admission may predict inpatient mortality in patients with CLD.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Approach and Results<\/jats:title>\n            <jats:p>We examined all patients with CLD in two large and diverse health care systems in Texas (North Texas [NTX] and Central Texas [CTX]) between 2010 and 2015. We developed (n\u00a0=\u00a03,588) and validated (n\u00a0=\u00a01,804) a model containing MELD and LA measured at the time of hospitalization. We further validated the model in a second cohort of 14 tertiary care hepatology centers that prospectively enrolled nonelective hospitalized patients with cirrhosis (n\u00a0=\u00a0726). MELD\u2010LA was an excellent predictor of inpatient mortality in development (concordance statistic [C\u2010statistic]\u00a0=\u00a00.81, 95% confidence interval [CI] 0.79\u20100.82) and both validation cohorts (CTX cohort, C\u2010statistic =\u00a00.85, 95% CI 0.78\u20100.87; multicenter cohort C\u2010statistic =\u00a00.82, 95% CI 0.74\u20100.88). MELD\u2010LA performed especially well in patients with specific cirrhosis diagnoses (C\u2010statistic =\u00a00.84, 95% CI 0.81\u20100.86) or sepsis (C\u2010statistic =\u00a00.80, 95% CI 0.78\u20100.82). For MELD score 25, inpatient mortality rates were 11.2% (LA\u00a0=\u00a01\u00a0mmol\/L), 19.4% (LA\u00a0=\u00a03 mmol\/L), 34.3% (LA\u00a0=\u00a05\u00a0mmol\/L), and &gt;50% (LA\u00a0&gt;\u00a08\u00a0mmol\/L). A linear increase (<jats:italic toggle=\"yes\">P<\/jats:italic>\u00a0&lt;\u00a00.01) was seen in MELD\u2010LA and increasing number of organ failures. Overall, use of MELD\u2010LA improved the risk prediction in 23.5% of patients compared to MELD alone.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>MELD\u2010LA (bswh.md\/meldla) is an early and objective predictor of inpatient mortality and may serve as a model for risk assessment and guide therapeutic options.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1002\/hep.31199","type":"journal-article","created":{"date-parts":[[2020,2,21]],"date-time":"2020-02-21T15:26:19Z","timestamp":1582298779000},"page":"1747-1757","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":53,"title":["Model for End\u2010Stage Liver Disease\u2010Lactate and Prediction of Inpatient Mortality in Patients With Chronic Liver Disease"],"prefix":"10.1097","volume":"72","author":[{"given":"Naveed","family":"Sarmast","sequence":"first","affiliation":[{"name":"Baylor University Medical Center,Baylor Scott and White,Dallas,TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerald O.","family":"Ogola","sequence":"additional","affiliation":[{"name":"Center for Clinical Effectiveness,Baylor Scott and White,Dallas,TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Kouznetsova","sequence":"additional","affiliation":[{"name":"Center for Clinical Effectiveness,Baylor Scott and White,Dallas,TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael D.","family":"Leise","sequence":"additional","affiliation":[{"name":"Mayo Clinic,Rochester,MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ranjeeta","family":"Bahirwani","sequence":"additional","affiliation":[{"name":"Baylor University Medical Center,Baylor Scott and White,Dallas,TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rakhi","family":"Maiwall","sequence":"additional","affiliation":[{"name":"Institute of Liver and Biliary Sciences,New Delhi,India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elliot","family":"Tapper","sequence":"additional","affiliation":[{"name":"University of Michigan,Ann Arbor,MI"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Trotter","sequence":"additional","affiliation":[{"name":"Baylor University Medical Center,Baylor Scott and White,Dallas,TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4928-3681","authenticated-orcid":false,"given":"Jasmohan S.","family":"Bajaj","sequence":"additional","affiliation":[{"name":"Virginia Commonwealth University,Richmond,VA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leroy R.","family":"Thacker","sequence":"additional","affiliation":[{"name":"Virginia Commonwealth University,Richmond,VA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Puneeta","family":"Tandon","sequence":"additional","affiliation":[{"name":"University of Alberta,Edmonton,AB,Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9263-8869","authenticated-orcid":false,"given":"Florence","family":"Wong","sequence":"additional","affiliation":[{"name":"University of Toronto,Toronto,ON,Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4898-7778","authenticated-orcid":false,"given":"K. 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