![]() ![]() 1 The MELD allocation system is based on the “sickest first” principle whereby individuals with the highest scores have priority access to organs. MELD scores were initially calculated from 3 laboratory values: creatinine, international normalized ratio of prothrombin rate (INR), and bilirubin. In 2002, the Organ Procurement and Transplantation Network (OPTN) adopted the model for end-stage liver disease (MELD) scoring system to allocate livers based on objective medical criteria. In simulations, the sex-adjusted MELDNa score modestly increased female transplant rate and decreased overall death.Ĭonclusions and Relevance These results demonstrate pervasive sex differences in all laboratory values used in MELDNa scoring and highlight the need and utility of a sex-adjustment to the MELDNa protocol. Female transplant patients had a greater number of decompensation traits (mean : male, 1.34 female, 1.60 P = .005), despite having lower MELDNa scores (mean : male, 21.72 female, 20.21 P = .005), indicating MELDNa scores are not accurately representing disease severity in female individuals. This pattern persisted when the sample was divided into healthy controls, individuals with liver disease who did not undergo transplant, and patients who did undergo liver transplant. All component MELDNa laboratory values and calculated MELDNa scores yielded significant sex differences within VUMC (mean creatinine: male, 0.99 mg/dL female, 0.79 mg/dL P < .001 bilirubin: male, 0.76 mg/dL female, 0.58 mg/dL P < .001 international normalized ratio of prothrombin rate: male, 1.24 female, 1.20 P < .001 sodium: male, 139.00 mEq/L female, 139.03 mEq/L P < .001), resulting in MELDNa scoring that disadvantaged female individuals. Results The VUMC sample was composed of 623 931 individuals (359 976 female) with a median (IQR) age of 44 (23-61) years. Main Outcomes and Measure Creatinine, bilirubin, international normalized ratio, and sodium levels. Analysis took place from November 2019 to March 2021.Įxposures Electronic health record–reported sex. Patients who regularly used VUMC with measurements for any MELDNa component laboratory were included in the analyses. Simulations of a sex-adjusted sodium-adjusted MELD (MELDNa) score were completed using liver transplant waiting list data from the liver simulated allocation modeling system. Replication analyses were conducted in the All of Us Research Program. Primary analyses were conducted in Vanderbilt University Medical Center (VUMC)’s deidentified electronic health record system. Objective To use laboratory values stored in electronic health records to describe population-level sex differences in all MELD laboratory values (in healthy individuals and patients with liver disease) and propose a sex adjustment.ĭesign, Setting, and Participants A retrospective cohort study was conducted from March 2019 to April 2020 to evaluate sex differences in laboratory values in liver transplant patients, patients with liver disease who did not undergo transplant, and healthy controls. During the MELD era, sex disparities in liver transplant have increased and there are no modifications to MELD based on sex. Importance Liver allocation is determined by the model for end-stage liver disease (MELD), a scoring system based on 4 laboratory measurements. Shared Decision Making and Communication.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience.Challenges in Clinical Electrocardiography.Decompensation counts by median calculated MELDNa stratified by sex and liver status Sex differences in decompensation counts stratified by liver status in VUMC and All of UsĮFigure 3. Sex differences in maximum a) creatinine, b) INR, c) bilirubin, d) sodium, and e) calculated MELDNa stratified by liver status in VUMCĮFigure 2. Sex differences in average decompensation counts stratified by sex and liver statusĮFigure 1. Sex differences in maximum MELDNa component labs and calculated MELDNa stratified by liver status in VUMCĮTable 9. Sex differences in median MELDNa component labs and calculated MELDNa stratified by liver status in All of UsĮTable 8. Sex differences in median MELDNa component labs and calculated MELDNa stratified by liver status in VUMCĮTable 7. Descriptive statistics of MELDNa component labs in the All of Us Research ProgramĮTable 6. Number of individuals with decompensation traits stratified by sex and liver statusĮTable 5. Decompensation phenotype ICD9 and ICD10 codesĮTable 4. Descriptive statistics of median MELDNa component labs and median calculated MELDNa stratified by sex and liver status in VUMCĮTable 3. Sample characteristics of Vanderbilt University Medical Center Synthetic Derivative (VUMC) and All of UsĮTable 2.
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