{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T16:01:56Z","timestamp":1791388916717,"version":"4.3.3"},"reference-count":45,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","license":[{"start":{"date-parts":[[2020,12,9]],"date-time":"2020-12-09T00:00:00Z","timestamp":1607472000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2020,12,9]],"date-time":"2020-12-09T00:00:00Z","timestamp":1607472000000},"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":["Liver Transpl."],"published-print":{"date-parts":[[2021,2]]},"abstract":"<jats:p>The burden of cirrhosis hospitalizations is increasing. The admission Model for End\u2010Stage Liver Disease\u2013lactate (MELD\u2010lactate) was recently demonstrated to be a superior predictor of in\u2010hospital mortality compared with MELD in limited cohorts. We identified specific classes of hospitalizations where MELD\u2010lactate may be especially useful and evaluated the predictive role of lactate clearance. This was a retrospective cohort study of 1036 cirrhosis hospitalizations for gastrointestinal bleeding, infection, or other portal hypertension\u2013related indications in the Veterans Health Administration where MELD\u2010lactate was measured on admission. Performance characteristics for in\u2010hospital mortality were compared between MELD\u2010lactate and MELD\/MELD\u2010sodium (MELD\u2010Na), with stratified analyses of MELD categories (\u226415, &gt;15 to &lt;25, \u226525) and reason for admission. We also incorporated day 3 lactate levels into modeling and tested for an interaction between day 1 MELD\u2010lactate and day 3 lactate clearance. MELD\u2010lactate had superior discrimination for in\u2010hospital mortality compared with MELD or MELD\u2010Na (area under the curve [AUC] 0.789 versus 0.776 versus 0.760, respectively; <jats:italic toggle=\"yes\">P<\/jats:italic>\u00a0&lt;\u00a00.001) and superior calibration. MELD\u2010lactate had higher discrimination among hospitalizations with MELD \u226415 (AUC 0.763 versus 0.608 for MELD, global <jats:italic toggle=\"yes\">P<\/jats:italic>\u00a0=\u00a00.01) and hospitalizations for infection (AUC 0.791 versus 0.674 for MELD, global <jats:italic toggle=\"yes\">P<\/jats:italic>\u00a0&lt;\u00a00.001). We found a significant interaction between day 1 MELD\u2010lactate and day 3 lactate clearance; heat maps were created as clinical tools to risk\u2010stratify patients based on these clinical data. MELD\u2010lactate had significantly superior performance in predicting in\u2010hospital mortality among patients hospitalized for infection and\/or with MELD \u226415 when compared with MELD or MELD\u2010Na. Incorporating day 3 lactate clearance may further improve prognostication.<\/jats:p>","DOI":"10.1002\/lt.25913","type":"journal-article","created":{"date-parts":[[2020,10,7]],"date-time":"2020-10-07T01:01:04Z","timestamp":1602032464000},"page":"177-189","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":33,"title":["The Predictive Role of Model for End\u2010Stage Liver Disease\u2013Lactate and Lactate Clearance for In\u2010Hospital Mortality Among a National Cirrhosis Cohort"],"prefix":"10.1097","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1889-3954","authenticated-orcid":false,"given":"Nadim","family":"Mahmud","sequence":"first","affiliation":[{"name":"Division of Gastroenterology and Hepatology,University of Pennsylvania Perelman School of Medicine,Philadelphia,PA"},{"name":"Leonard Davis Institute of Health Economics,University of Pennsylvania Perelman School of Medicine,Philadelphia,PA"},{"name":"Gastroenterology Section,Corporal Michael J. Crescenz VA Medical Center,Philadelphia,PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9174-5670","authenticated-orcid":false,"given":"Sumeet K.","family":"Asrani","sequence":"additional","affiliation":[{"name":"Baylor University Medical Center,Baylor Scott and White Health,Dallas,TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David E.","family":"Kaplan","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology,University of Pennsylvania Perelman School of Medicine,Philadelphia,PA"},{"name":"Gastroenterology Section,Corporal Michael J. Crescenz VA Medical Center,Philadelphia,PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerald O.","family":"Ogola","sequence":"additional","affiliation":[{"name":"Center for Clinical Effectiveness,Baylor Scott and White Research Institute,Dallas,TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tamar H.","family":"Taddei","sequence":"additional","affiliation":[{"name":"Division of Digestive Diseases,Yale University School of Medicine,New Haven,CT"},{"name":"VA Connecticut Healthcare System,West Haven,CT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick S.","family":"Kamath","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology,Mayo Clinic College of Medicine and Science,Rochester,MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4899-2160","authenticated-orcid":false,"given":"Marina","family":"Serper","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology,University of Pennsylvania Perelman School of Medicine,Philadelphia,PA"},{"name":"Leonard Davis Institute of Health Economics,University of Pennsylvania Perelman School of Medicine,Philadelphia,PA"},{"name":"Gastroenterology Section,Corporal Michael J. 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