MELD 3.0 score in prediction of varices and comparison with its previous versions in patients undergoing esophago-gastro-duodenoscopy for variceal screening or band ligation

TL;DR

The study compares MELD score versions in predicting esophageal varices in patients undergoing endoscopy, finding MELDNa has the highest accuracy.

Contribution

The study evaluates and compares the predictive accuracy of MELD, MELDNa, and MELD 3.0 scores for esophageal varices in endoscopy patients.

Findings

MELD 3.0 had the highest scores for presence of varices (19.21).

MELDNa showed the highest area under the curve (AUC) for predicting varices.

MELD 3.0 gives equal scores to males and females, unlike MELD and MELDNa.

Abstract

To compare MELD, MELDNa & MELD 3.0 score values with presence of varices in patients undergoing esophago-gastro-duodenoscopy for variceal screening or band ligation. The other objective was to estimate cut-off values of various MELD variants in prediction of varices using Area Under Receiver Operator Curve (AUROC).

This cross-sectional study was conducted in Department of Medicine/Gastroenterology at Dow Medical College, Karachi during the period 20th November 2022 to 19th September 2024. All patients of either gender of age between 18 to 65 years undergoing screening endoscopy were included in the study after informed consent. MELD, MELDNa & MELD 3.0 scores were calculated, grades of oesophageal varices were recorded.

Total of 321 patients were included. Highest scores for presence of varices were reported by MELD 3.0 (19.21). No difference was found for variceal presence on gender in MELD 3.0 scores but MELD & MELDNa scores were significantly lower in females. All MELD variants showed significant area under curve on ROC with highest AUC in MELDNa. Regression analysis for MELD variants showed that 88.8% of MELD 3.0 score was influenced by age, gender, bilirubin, sodium, INR, creatinine & albumin. Age, sodium & albumin affected negatively on the score. In both MELD and MELDNa scores albumin levels did not have any significant effect on score.

All MELD variants have good predictability for varices at their different scores with MELDNa showing highest AUC. MELD 3.0 gives more weightage to female gender by allocating them score that are not different from males, while the other two allocate lower scores to females.

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