Model for End Stage Liver Disease (MELD), Predictor of 30-Day Readmission Rate: A Systematic Review and Meta-Regression Analysis

Abstract

Introduction: Patients admitted to the hospital with liver disease have a high rate of 30 days' readmission, particularly those with liver cirrhosis and post orthotopic liver transplantation. We performed a systemic review and meta-analysis to assess the ability of MELD score in predicting 30 days' readmission rate. Methods: A systematic search using search terms of “liver cirrhosis” and “hospital readmission” from major literature databases and manual search from their inceptions until 3 June, 2017 was conducted to identify studies examining the association between the Model for End-stage Liver Disease (MELD) and all-cause 30-day readmission rate. Meta-regression analysis was conducted to examine statistical significance with visual presentation. Results: Of the reviewed 103 articles found in the search strategy, we reviewed the full text of eligible 29 articles and excluded of those 22 articles, which resulted in a final 7 studies for analysis. A total of 14,294 patients were analyzed. The pooled mean MELD score was 16.755 with standard error 1.065 and 95% confidence intervals (CI) 14.667 to 18.842. All-cause 30-day readmission rates ranged 16.0% to 37.9%. The MELD score was associated with 30-day readmission rate (coefficient = 1.000; 95% CI 0.905 to 1.095; p <.001). Conclusion: Along with short-term mortality predictor usage, the MELD score might be used as a predictor of early hospital readmission in patients with liver cirrhosis.Table: Table. Summary of studiesFigure: Regression of MELD score on 30 days readmission rate.Figure: PRISMA study selection process for meta-regression study.