Introduction:Subpopulations of patients with liver cirrhosis exist for whom the Model for End-Stage Liver Disease Sodium Score (MELDNa) is suboptimal for mortality prediction and who may benefit from liver transplantation. We examine whether racial differences in liver cirrhosis related mortality are observed in these subpopulations.

Methods: We used aggregated EHR data from 5 academic centers and 1 county healthcare system in the greater Chicago area (HealthLNK) which contains data on patients followed from Jan 2006 to Dec 2012. Patients with liver cirrhosis were identified using ICD-9 codes 571.2, 571.5 and 571.6. Those with a maximum MELDNa scores ≤ 15 were stratified according to race-white or black. Analysis employed a cox model with interaction terms.

Results: Longitudinal data about 5,126 adult patients with cirrhosis were used. Of these, 2017 (39%) patients had a maximum MELDNa score ≤15. 1316 (65%) were white. 701 (35%) were black. 1 year 3 year and 5 year mortality among white patients was 3.5%, 11.3% and 16.5% respectively. Among black patients it was 5.9%, 12% and 20% respectively. The difference in mortality was not statistically significant (p=0.08). Using a multivariate cox proportional hazards model, severe hypoalbuminemia (maximum serum albumin <2.8g/dL) (HR 4.9 ; CI 3.3-7.2), hepatorenal syndrome (HR 3.9; CI 1.4-11.0), moderate hypoalbuminemia (maximum serum albumin 2.8-3.5 g/dL) (HR 2.9; CI 2.1-4.0), ascites (HR 1.7 ; CI 1.3-2.4) hepatic hydrothorax (HR 1.7; CI 1.1-2.7) and malnutrition (HR 1.5; CI 1.02-2.15), were associated with an increased risk of death, independent of MELDNa score. When interaction terms were introduced into the cox model the effect of severe hypoalbuminemia was noted to differ by race (p=0.0076). White patients with severe hypoalbuminemia had a HR of 7.8 (CI 4.8-12.7) while black patients had a HR of 2.8 (CI 1.5-5.1). Racial differences were not observed for moderate hypoalbuminemia, ascites, hepatic hydrothorax and malnutrition.

Conclusion:

Among patients with MELDNa ≤15, severe hypoalbuminemia confers a more than 2 1/2 increased risk of death for white compared to black patients. These results can inform decisions regarding treatments including liver transplantation.

CITATION INFORMATION: Atiemo K, Maddur H, Zhao L, Skaro A, Montag S, VanWagner L, Goel S, Kho A, Kang R, Holl J, Abecassis M, Levitsky J, Kulik L, Ladner D. Racial Differences in Liver Cirrhosis-Related Mortality Among Patients with Model for End-Stage Liver Disease Sodium Score (MELDNa) ≤ 15. Am J Transplant. 2017;17 (suppl 3).

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