Nikhilesh R Mazumder1,2, Kofi Atiemo1, Amna Daud1, Abel Kho3, Michael Abecassis1, Josh Levitsky2, Daniela P Ladner1,4. 1. Northwestern University Transplant Research Collaborative (NUTORC), Comprehensive Transplant Center (CTC), Feinberg School of Medicine, Northwestern University, Chicago, IL. 2. Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University, Chicago, IL. 3. Center for Health Information Partnerships, Institute for Public Health and Medicine, Chicago, Northwestern University, Chicago, IL. 4. Center for Healthcare Studies, Institute for Public Health and Medicine, Northwestern University, Chicago, IL.
Abstract
BACKGROUND: The vast majority of patients with cirrhosis have low Model for End-Stage Liver Disease-Sodium (MELD-Na) scores; however, the ability for the MELD-Na score to predict patient outcomes at low scores is unclear. METHODS: Adult patients in a multicenter, Chicago-wide database of medical records with International Classification of Disease, Ninth Edition codes of cirrhosis and without a history of hepatocellular carcinoma were included. Records were linked with the state death registry, and death certificates were manually reviewed. Deaths were classified as "liver-related," "non-liver-related," and "non-descript" as adjudicated by a panel comprised of a transplant surgeon, a hepatologist, and an internist. A sensitivity analysis was performed where patients with hepatocellular carcinoma were included. RESULTS: Among 7922 identified patients, 3999 patients had MELD-Na scores that were never higher than 15. In total, 2137 (27%) patients died during the study period with higher mortality rates for the patients in the high MELD-Na group (19.4 (41.6%) versus 4.1 (12.6%) per 100 person-y, P < 0.001). The high MELD-Na group died of a liver-related cause in 1142 out of 1632 (70%) as compared to 240 out of 505 (47.5%) deaths in the low MELD-Na group. There was no difference in the distribution of subcategory of liver-related death between low and high MELD-Na groups. Among subclassification of liver-related deaths, the most common cause of death was "Infectious" in both groups. CONCLUSIONS: Despite persistently low MELD-Na scores, patients with cirrhosis still experience high rates of liver-related mortality.
BACKGROUND: The vast majority of patients with cirrhosis have low Model for End-Stage Liver Disease-Sodium (MELD-Na) scores; however, the ability for the MELD-Na score to predict patient outcomes at low scores is unclear. METHODS: Adult patients in a multicenter, Chicago-wide database of medical records with International Classification of Disease, Ninth Edition codes of cirrhosis and without a history of hepatocellular carcinoma were included. Records were linked with the state death registry, and death certificates were manually reviewed. Deaths were classified as "liver-related," "non-liver-related," and "non-descript" as adjudicated by a panel comprised of a transplant surgeon, a hepatologist, and an internist. A sensitivity analysis was performed where patients with hepatocellular carcinoma were included. RESULTS: Among 7922 identified patients, 3999 patients had MELD-Na scores that were never higher than 15. In total, 2137 (27%) patients died during the study period with higher mortality rates for the patients in the high MELD-Na group (19.4 (41.6%) versus 4.1 (12.6%) per 100 person-y, P < 0.001). The high MELD-Na group died of a liver-related cause in 1142 out of 1632 (70%) as compared to 240 out of 505 (47.5%) deaths in the low MELD-Na group. There was no difference in the distribution of subcategory of liver-related death between low and high MELD-Na groups. Among subclassification of liver-related deaths, the most common cause of death was "Infectious" in both groups. CONCLUSIONS: Despite persistently low MELD-Na scores, patients with cirrhosis still experience high rates of liver-related mortality.
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Authors: Nikolaj Torp; Mads Israelsen; Bjørn Madsen; Philipp Lutz; Christian Jansen; Christian Strassburg; Christian Mortensen; Anne Wilkens Knudsen; Grith Lykke Sorensen; Uffe Holmskov; Anders Schlosser; Maja Thiele; Jonel Trebicka; Aleksander Krag Journal: JHEP Rep Date: 2021-08-27
Authors: Nikolaj Torp; Mads Israelsen; Bjørn Madsen; Philipp Lutz; Christian Jansen; Christian Strassburg; Christian Mortensen; Anne Wilkens Knudsen; Grith Lykke Sorensen; Uffe Holmskov; Anders Schlosser; Maja Thiele; Jonel Trebicka; Aleksander Krag Journal: JHEP Rep Date: 2021-03-29