P2799 - Disparities in Performance of the Model for End-Stage Liver Disease Score Across Different Races and Ethnicities

Maria Mironova, MD¹, Eptehal Nashnoush, BS², Irina Y. Gutierrez Puentes, MD³, Leo A. Celi, MD, MPH, MS⁴, Daniel J. Stein, MD, MPH^5
1Capital Health, Princeton, NJ; ²Dalhousie University, Halifax, NS, Canada; ³Capital Health, Trenton, NJ; ⁴Massachusetts Institute of Technology, Cambridge, MA; ⁵Brigham & Women's Hospital, Boston, MA

Introduction: The prevalence of cirrhosis has doubled in the past decade, and it became the 11th leading cause of death in the United States in 2017. The Model for End-Stage Liver Disease (MELD) score stratifies the severity of end-stage liver disease and is used to prioritize liver transplantation. It has also been validated as a predictor of in-hospital mortality for patients with cirrhosis. Despite the score’s widespread adoption, there has been little research on the impact of the patient’s race-ethnicity on the score’s performance.

Methods: The performance of the MELD score in predicting in-hospital mortality for the Asian, African American, Hispanic, and White patient groups was compared for 11,326 admission records in the Medical Information Mart for Intensive Care IV database for patients with cirrhosis. The binned 90-days mortality rates proposed by Wiesner et al. [1] were used to determine the comparative MELD scores. Discrimination and calibration were determined for the score in all four groups. Discrimination of the MELD score was determined by the area under the receiver operating characteristic (AUROC) curve, and calibration was evaluated using a standardized mortality ratio (SMR) between actual and predicted mortality ratios in each predicted mortality category.

Results: The across-group difference in the AUROCs was statistically significant (p=0.01). In the subgroup comparisons, there was a separation between the Hispanic and White patients, but all other comparisons had overlapping 95% confidence intervals. Calibration showed that the overall SMR for African Americans was lower than for all ethnicities by 60.3%. A similar trend was observed in the analysis across mortality categories, where the SMRs for African Americans were lower than for all ethnicities across all categories. In addition, the SMRs for Hispanics were lower than for all ethnicities across three mortality categories (Table 1).

Discussion: The MELD score is commonly used to inform clinical decisions for patients with cirrhosis. Our analysis suggests racial disparities in the accuracy of its estimate of mortality among hospitalized patients. Further work is needed to identify the etiology of these disparities and ensure consistent performance of the score across all races and ethnicities.


REFERENCES:

1. Wiesner R, Edwards E, Freeman R, et al. Model for end-stage liver disease (MELD) and allocation of donor livers. Gastroenterology. 2003;124(1):91-96.

		All	Asian	African American	Hispanic	White	p-value
AUROC, (CI)		0.76	0.71	0.78	0.85	0.76	0.01
		(0.75, 0.78)	(0.62, 0.81)	(0.72, 0.84)	(0.8, 0.9)	(0.74, 0.78)
Overall SMR		0.37	0.41	0.23	0.35	0.44	0.1
SMR for 90-days survival rates	1.9%	0.27	0.00	0.00	0.55	0.54
	6.0%	0.42	0.87	0.34	0.07	0.41
	19.6%	0.34	0.47	0.22	0.28	0.39
	52.6%	0.40	0.37	0.34	0.51	0.40
	71.3%	0.42	0.35	0.40	0.38	0.53

Table: Table 1: The Comparison of the Measures of Discrimination and Calibration Across Various Ethnicities (AUROC - area under the receiver operating characteristic curve, CI - confidence interval, SMR - standardized mortality ratio).


Disclosures:
Maria Mironova indicated no relevant financial relationships.
Eptehal Nashnoush indicated no relevant financial relationships.
Irina Gutierrez Puentes indicated no relevant financial relationships.
Leo Celi indicated no relevant financial relationships.
Daniel Stein indicated no relevant financial relationships.


Maria Mironova, MD¹, Eptehal Nashnoush, BS², Irina Y. Gutierrez Puentes, MD³, Leo A. Celi, MD, MPH, MS⁴, Daniel J. Stein, MD, MPH⁵. P2799 - Disparities in Performance of the Model for End-Stage Liver Disease Score Across Different Races and Ethnicities, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.