MELD Score Kinetics in Decompensated HIV+/HCV+ Patients: A Useful Prognostic Tool (ANRS HC EP 25 PRETHEVIC Cohort Study)

Moana Gelu-Simeon (1, 2) , Tatiana Bayan , Maria Ostos , Faroudy Boufassa (3) , Elina Teicher , Jean-Marc Steyaert , Inga Bertucci , Rodolphe Anty (4, 5) , Georges-Philippe Pageaux (6) , Laurence Meyer (7) , Jean-Charles Duclos-Vallée (8, 9, 10)

1 Hôpital Paul Brousse
2 Irset - Institut de recherche en santé, environnement et travail
3 CESP - Centre de recherche en épidémiologie et santé des populations
4 C3M - Centre méditerranéen de médecine moléculaire
5 Département Digestif
6 Cellules Souches, Plasticité Cellulaire, Médecine Régénératrice et Immunothérapies (IRMB)
7 BMNST - Biopathologie de la Myéline, Neuroprotection et Stratégies Thérapeutiques
8 Pathogénèse et traitement de l'hépatite fulminante et du cancer du foie
9 CHB - Centre hépato-biliaire
10 Virus Hépatotropes et Cancers

To assess prognostic factors for survival and describe Model for End-Stage liver disease (MELD) dynamics in human immunodeficiency virus+/hepatitis C virus+ (HIV+/HCV+) patients after an initial episode of hepatic decompensation.An HIV+/HCV+ cohort of patients experiencing an initial decompensation episode within the year preceding enrollment were followed prospectively. Clinical and biological data were collected every 3 months. Predictors for survival were identified using Kaplan-Meier curves and Cox models. A 2-slope-mixed linear model was used to estimate MELD score changes as a function of survival.Sixty seven patients were included in 32 centers between 2009 and 2012 (72% male; median age: 48 years [interquartile ratio (IQR):45-52], median follow-up: 22.4 months [range: 0.5-65.3]). Overall survival rates were 86%, 78%, and 59% at 6, 12, and 24 months, respectively. Under multivariate analysis, the MELD score at initial decompensation was predictive of survival, adjusted for age, type of decompensation, baseline CD4 counts, and further decompensation during follow-up as a time-dependent variable. The adjusted hazard ratio of death was 1.32 for a score 3 points higher (95% CI: [1.06-1.63], P = 0.012). MELD score kinetics within the 6 months after initial decompensation differed significantly between non-deceased and deceased patients, with a decreased (-0.49/month; P = 0.016), versus a flat (+0.06/month, P = 0.753) mean change in score.MELD is an effective tool to predict survival in HIV+/HCV+ patients with decompensated cirrhosis. A non-decreasing MELD score within 6 months following this initial decompensation episode may benefit from privileged access to liver transplantation in this poor prognosis population

Domaines: Sciences du Vivant [q-bio]

Moana Gelu-Simeon, Tatiana Bayan, Maria Ostos, Faroudy Boufassa, Elina Teicher, et al.. MELD Score Kinetics in Decompensated HIV+/HCV+ Patients: A Useful Prognostic Tool (ANRS HC EP 25 PRETHEVIC Cohort Study). Medicine, 2015, 94 (30), pp.e1239. ⟨10.1097/MD.0000000000001239⟩. ⟨hal-01205351⟩