The model for end-stage liver disease (MELD) predicts survival of liver cirrhosis patients after discharge to hospice

Abstract

Aim: To assess if the Model for End-stage Liver Disease (MELD) score correlates with survival of liver cirrhosis patients after discharge to hospice.

Methods: Patients who were discharged to a hospice program for decompensated liver cirrhosis during a 7-year period were identified. MELD score was calculated for all patients. Medical records and the Social Security Death Index (SSDI) were used to determine the exact date of death and survival after discharge.

Results: Fifty patients were identified. Average MELD score was 26.4. Exact date of death was available for 42 of these patients. Average survival after discharge to hospice was 36.83 days. There was a moderate correlation (r=-0.61, P<0.0001) between MELD scores and survival after hospice discharge. The area under the receiver operating characteristic curve for MELD score predicting 30-day mortality was 0.84. MELD score >/=25 predicted 30-day mortality with a sensitivity of 74.19%, a specificity of 90.91%, and an accuracy of 78.58%. The positive predictive value was 95.83% and the negative predictive value 55.56%.

Conclusions: Patients with cirrhosis who are not candidates for liver transplantation are referred to hospice care at a late stage with an average survival of 1 month. The MELD score correlates with survival of cirrhosis patients enrolled in hospice and can be used to estimate 30-day mortality. Further, research is needed to determine a MELD score that predicts a survival of 6 months or less, an important determinant of appropriate hospice referrals.