(441) Liver Failure: The Effect of Modified MELD Score: Pre and Post 5-Year Comparison

Introduction: The Model for End-Stage Liver Disease (MELD) score is a predictive tool offering insights into the mortality rates of patients awaiting liver transplantation. The MELD score is calculated using three key laboratory values: serum bilirubin, serum creatinine, and the international normalized ratio (INR). In 2016, Sodium was added as an additional determining factor for MELD. This was to effectively identify a subgroup of patients with poor outcomes compared to using the MELD score alone. Despite the theorized benefits of adding serum sodium to the MELD score, a knowledge gap regarding its full impact on patient outcomes somewhat remains unknown. Therefore, this study was conducted to look into the question did the addition of Sodium (Na) to the MELD score have any association with a reduction in overall mortality due to liver disease?

Methods: Data on liver disease mortality were extracted from CDC’s WISQARS (Web-based injury statistics query and reporting system). The trends in liver disease-related mortality were compared before and after the addition of Sodium to MELD scoring systems.

Results: Our analysis from 2011-2020 demonstrated that the total number of liver disease-related deaths for 5 years from 2011-2015 was 183,544 which increased to 221,126 in the 5 years from 2016-2020. This represents a 20.48% increase in total mortality in 5 years post Na MELD score introduction. Moreover, an increasing trend was reported in the crude death rate (2011: 10.8% vs. 2015:12.6% vs. 2020:15.6%) from 2011 to 2020. However, an increasing trend was not observed in the percentage mortality (2011: 1.6% vs. 2015:1.8% vs. 2020:1.8%) which increased from 2011 to 2014 only.

Conclusions: Our results conclude that there was a 20.48% increase in 5-year liver disease mortality was observed post Na MELD introduction in January 2016. The modified MELD-Na score did not tangibly improve the prognostic predictive capability for liver failure patients. This is in line with previous literature showing that Na MELD scoring was not useful in predicting 90-day mortality in patients with Acute-on-Chronic Liver Failure (ACLF). To accurately predict the impact of the modified MELD-Na score, further parameters may need to be added such as such as age, gender, alcohol consumption, and other comorbidities.