MELD Trajectory of people dying of LC
In the LC trial after only 3 months people on Emricasan decreased their MELD score by 1.6 (from avg ca 16) and patients on placebo increased by 0.6 (from avg ca 16). Trajectory seems to be leading to unfortunately death for people on placebo and to reversal for people on Emricasan. We will know more at 6 months read out within a few weeks
'The trajectory of the MELD score prior to death in patients who die on the liver transplant waitlist has not previously been explored. Better understanding patterns that occur just prior to waitlist death might help identify and prioritize patients at high risk for a "downward spiral".
We analyzed 42,192 MELD values reported to UNOS in the 365 days prior to death for 11,885 waitlisted adults, excluding exceptions/Status 1, who died between 3/2002-2/2010. We estimated percent change in MELD score over time using random-intercept longitudinal models.
Median (IQR) MELD was 14(12-20) at 365 days prior to death (DPD), climbing gradually to 21.5 (17-26) at 30 DPD(Figure 1). It then rose sharply to 30 (24-37) at 10 DPD and 35 (26-40) on the date of death. An individual's MELD increased weekly by average 0.38% (95% CI 0.37%-0.39%) from 365 DBD to 60 DBD, 13.1%-14.9%) in the week before death. The proportion of patients with MELD=40 was 13.3% at 14 DPD, 19.5% at 7 DPD, and 33.9% on the date of death' Less
