MELD-Na predicts 6-month mortality in decompensated cirrhosis patients

A score of 28 in the Model of End-stage Liver Disease—Sodium (MELD-Na), an objective measure to identify patients with decompensated cirrhosis who are at increased risk of 6-month mortality in time-constrained settings, may prompt talks about hospice to improve value-based healthcare in these individuals, suggests a recent study.

The authors conducted this retrospective cross-sectional analysis using information from the United Network of Organ Sharing (UNOS) database covering 27 February 2002 to 30 September 2019. Patients aged ≥18 years with a diagnosis of cirrhosis, eligible for liver transplant, and listed in the UNOS database were included in the analysis.

Individuals with fulminant hepatic failure, prior history of liver transplantation, a diagnosis of hepatocellular carcinoma, who received liver transplant in <180 days, or removed from waiting list <180 days for a reason other than death were excluded.

A total of 93,157 patients met the inclusion criteria. Of these, 79,611 had available data on sodium, total bilirubin, international normalized ratio, and creatinine and had their MELD-Na calculated.

MELD-Na for the predicted 6-month mortality had a c-statistic of 0.83 (95 percent confidence interval, 0.827‒0.835). A mean MELD-Na of 28.2 was predictive of ≤50-percent 6-month survival.

“End-stage liver disease patients underutilize hospice services despite significant morbidity and mortality associated with advanced liver disease,” the authors said.

“A well-known barrier to hospice referral is clinician uncertainty in identifying patients with an expected survival of <6 months, a requirement for a referral,” they added.