Enhancement of Cirrhosis Mortality Prediction by Including Hepatic Encephalopathy to MELD 3.0 in a National Veteran Cohort.

Abstract

Despite negative outcomes, hepatic encephalopathy (HE) is not included in the Model for End-Stage Liver Disease (MELD) scores, including MELD 3.0. In a National Veterans Affairs database, we studied the additive mortality predictive impact of a documented inpatient overt HE diagnosis on MELD 3.0 and MELD-sodium (MELD-Na) scores in 75,327 veterans (26.8% with HE, 22% 90-day and 37% 1-year mortality). The addition of HE to MELD 3.0 and MELD-Na significantly improved their mortality prediction with interactions at 90 days and 1 year on multivariable regression. A documented inpatient HE episode is additive to the mortality prediction of MELD 3.0 by 4-5 extra points and could enhance future MELD iterations.