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MELD and the Risk of Mortality Between Black and White Patients with Advanced Fibrosis
Michael L Attanasi1,2, Mathew J Gregoski2,3, Don C Rockey4
1Department of Internal Medicine, North Shore University Hospital, Manhasset, N.Y, USA.
Purpose:
MELD has been well established as the gold standard metric for predicting mortality in patients with cirrhosis. Here, we hypothesized that Black race is an important factor in predicting mortality in patients with cirrhosis when controlling for social determinants of health.
Methods:
All adults who had a liver biopsy showing F4 fibrosis at our institution from January 1, 2013 through July 1, 2021 were identified. Histology, fibrosis stage, and complete clinical data were abstracted. Patients were propensity matched based on age, gender, Charlson Comorbidity Index, and the CDC/ATSDR Social Vulnerability Index Themes 1, 2, and 4. Cox Proportional Hazard Modeling was used to identify if race was a predictor of 5-year liver-related mortality. Logistic regression analysis was performed comparing race, MELD 3.0, and their interaction on ninety-day liver-related mortality.
Results:
Of 3572 patients having a liver biopsy, 64 Black and 61 White patients had F4 fibrosis after propensity matching. No significant differences between these groups existed for MELD scores. Liver-related mortality at 5 years was not significantly different between White and Black patients. Logistic regression analysis did not reveal an association between race and liver-related mortality.
Conclusion:
Black and White patients with similar comorbidities and social vulnerabilities had comparable liver-related mortality at similar MELD 3.0 scores. The data suggest that the MELD 3.0 score is equally predictive of mortality in Black and White patients.