AimStudies suggest that certain patients with liver cirrhosis and a low MELD score (<15) remain at high risk for mortality. Current data is largely limited to transplant registry data which only captures a fraction of this patient population. Our aim was to assess the mortality rate among patients with a low MELD in a large population and to determine factors associated with this mortality.MethodHealthLNK(HL) captures EMRdata for ~2 million patients treated within 6 diverse healthcare networks in the greater Chicago area (Northwestern, Univ of Chicago, Rush Univ, Univ of IL of Chicago, Loyola Univ, Cook County) between 2006 and 2012. HLdata were merged with UNOS and death registry data. Patients with cirrhosis were identified by ICD9 (571.2, 571.5, 571.6) and Fib-4 scores. MELD scores were calculated and demographics were collected. The low MELD score cohort was identified as patients whose MELD was never ≥15 during the study.Low to high MELD cohort had an initial MELD <15 but a final MELD ≥15.The high MELD cohort consisted of patients with an initial MELD score ≥15. A multivariate cox proportional hazards model was fitted to determine factors associated with mortality.ResultA cohort of 9880 patients with cirrhosis was identified. 6928 patients had an initial MELD<15 of which 4946 had a MELD never≥15 during the study. 2952 had an initial MELD≥15. The low vs high MELD group both had mean age 62 yrs. 53% v 63% were male, 61% v 58% white, etiology of cirrhosis was ETOH for 23% v 43%, NASH 19% v 13% and HCV 37% v 27%. 1089 (29%)v1318(45%) died during the study period (median fu 38mo; min0.6,max83). Mortality in patients with MELD <15 throughout the study period was increased with malnutrition(HR2.9;95%CI2.4,3.3),HRS(HR2.7;95%CI1.6,4.4),ascites(HR1.7;95%CI1.5,2.0), HE(HR1.4;95%CI1.2,1.7),thrombocytopenia(HR1.4;95%CI1.1,1.5), male(HR1.395%CI1.1,1.5), and age(yr)(HR1.04;95%CI1.0,1.1).Factors associated with a reduced mortality were HCV(HR0.76;95%CI0.7,0.9), NASH(HR0.51;95%CI0.4,0.7) and variceal bleeding(HR0.67;95%CI0.5,0.9).All factors p<0.001.ConclusionMortality among cirrhotic patients with a low MELD is higher than previously reported. ~30% of cirrhotic patients died within ~3 years despite never raising their MELD ≥15. Patients at highest risk are those with malnutrition. Identification of low MELD patients at high risk of death is important for alternate treatments such as LDLT or priority in organ allocation.

CITATION INFORMATION: Atiemo K, Zhao L, Skaro A, VanWagner L, Goel S, Kho A, Ho B, Kang R, Montag S, Holl J, Abecassis M, Ladner D. Factors Associated with Mortality Among a Large Population of Patients with Cirrhosis and a Low MELD (<15). Am J Transplant. 2016;16 (suppl 3).

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