![]() The clinical sequelae of portal hypertension such as ascites, varices, and variceal bleeding have been identified as risk factors for death independent of the MELD score, and these clinical parameters may be particularly important in patients with low MELD scores 6- 8.ĭ’Amico et al described discrete stages in which cirrhotic patients can be classified 9, 10. ![]() There are limitations in the MELD score’s predictive ability for certain subpopulations of transplant patients 1- 5. Predicting risk of death on the liver transplant (LT) waiting list is the goal of risk stratification tools like the model for end stage liver disease (MELD) score, which has been used as the backbone for liver graft allocation in the United States since 2002. In conclusion, assessing the cirrhosis stage in low MELD patients awaiting LT may help select candidates for more aggressive monitoring or for living donor or extended criteria donation. In a multivariable model including cirrhosis stage, albumin, sodium, and hepatic encephalopathy, increasing cirrhosis stage (p=0.010) was independently associated with liver-related death. In univariate analyses, variceal bleed (OR 5.6, p= 0.003), albumin (OR 0.5, p=0.041), increasing cirrhosis stage (p=0.003) and reaching stage 2, 3, or 4 cirrhosis versus lower stages (OR 3.6, p=0.048 OR 7.4, p<0.001 OR 4.1, p=0.008 respectively), sodium < 135 (OR 3.4, p=0.006), and hepatic encephalopathy (OR 2.3, p=0.082) were associated with liver-related death. Clinical states contributing to death in cases were: sepsis 48%, spontaneous bacterial peritonitis 42%, variceal bleeding 24%, and hepatorenal syndrome 21%. MELD scores were similar for cases and controls. ![]() Cirrhosis stage (1=no varices or ascites, 2=varices, 3=variceal bleed, 4=ascites, 5=ascites and variceal bleed) was assessed for all subjects. Cases were matched with up to 3 controls, totaling 66 controls, based on listing year, age, gender, liver disease etiology, hepatocellular carcinoma, and MELD. We identified 41 case subjects who died from liver-related causes with a MELD ≤ 20 within 90 days of death while waiting for LT. Conditional logistic regression was used to evaluate the risk of liver-related death based on cirrhosis stage. We conducted a case-control study of cirrhotic subjects with MELD ≤ 20 awaiting LT at a single academic medical center from 2/2002-5/2011. We aimed to assess whether a 5-stage clinical model identifies liver transplant (LT) candidates with low MELD who are at increased risk for death. MELD has reduced predictive ability in cirrhotic patients with MELD ≤ 20.
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