Skip to main content

MELD-Na Accurately Predicts 6-Month Mortality in Patients With Decompensated Cirrhosis: Potential Trigger for Hospice Referral.

Publication ,  Journal Article
Brown, C; Aksan, N; Muir, AJ
Published in: J Clin Gastroenterol
November 2022

GOAL: The goal of this study was to determine the accuracy of Model of End-stage Liver Disease-Sodium (MELD-Na) in predicting 6-month mortality for patients listed for liver transplantation on the United Network of Organ Sharing (UNOS) waitlist. BACKGROUND: End-stage liver disease patients underutilize hospice services despite significant morbidity and mortality associated with advanced liver disease. 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. METHODS: Retrospective cross-sectional analysis was performed from UNOS data spanning February 27, 2002, to September 30, 2019. Inclusion criteria of patients aged 18 years and above, diagnosis of cirrhosis, liver transplant eligible, and listed in the UNOS database. Exclusion criteria included fulminant hepatic failure, prior history of liver transplantation, diagnosis of hepatocellular carcinoma, receipt of liver transplant in <180 days, or removal from waiting list <180 days for a reason other than death. MEASUREMENT: Mortality by 180 days. RESULTS: Of the 93,157 patients that met inclusion criteria, MELD-Na was calculated for all patients with sodium, total bilirubin, international normalized ratio, and creatinine available (N=79,611). The c -statistic with 95% confidence interval for MELD-Na for the predicted 6-month mortality was 0.83 (0.827-0.835). Mean MELD-Na of 28.2 was associated with ≤50% 6-month survival. CONCLUSION: MELD-Na is an objective, quick measure that can aid providers in identifying patients with increased 6-month mortality in time-constrained settings, and a score of 28 can trigger the discussion for hospice as a means of improving value-based health care.

Duke Scholars

Altmetric Attention Stats
Dimensions Citation Stats

Published In

J Clin Gastroenterol

DOI

EISSN

1539-2031

Publication Date

November 2022

Volume

56

Issue

10

Start / End Page

902 / 907

Location

United States

Related Subject Headings

  • Sodium
  • Severity of Illness Index
  • Retrospective Studies
  • Referral and Consultation
  • Prognosis
  • Liver Neoplasms
  • Liver Failure, Acute
  • Liver Cirrhosis
  • Humans
  • Hospices
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Brown, C., Aksan, N., & Muir, A. J. (2022). MELD-Na Accurately Predicts 6-Month Mortality in Patients With Decompensated Cirrhosis: Potential Trigger for Hospice Referral. J Clin Gastroenterol, 56(10), 902–907. https://doi.org/10.1097/MCG.0000000000001642
Brown, Cristal, Nazan Aksan, and Andrew J. Muir. “MELD-Na Accurately Predicts 6-Month Mortality in Patients With Decompensated Cirrhosis: Potential Trigger for Hospice Referral.J Clin Gastroenterol 56, no. 10 (November 2022): 902–7. https://doi.org/10.1097/MCG.0000000000001642.
Brown, Cristal, et al. “MELD-Na Accurately Predicts 6-Month Mortality in Patients With Decompensated Cirrhosis: Potential Trigger for Hospice Referral.J Clin Gastroenterol, vol. 56, no. 10, Nov. 2022, pp. 902–07. Pubmed, doi:10.1097/MCG.0000000000001642.

Published In

J Clin Gastroenterol

DOI

EISSN

1539-2031

Publication Date

November 2022

Volume

56

Issue

10

Start / End Page

902 / 907

Location

United States

Related Subject Headings

  • Sodium
  • Severity of Illness Index
  • Retrospective Studies
  • Referral and Consultation
  • Prognosis
  • Liver Neoplasms
  • Liver Failure, Acute
  • Liver Cirrhosis
  • Humans
  • Hospices