studies

490A AASLD ABSTRACTS HEPATOLOGY, October, 2015
of patients with cirrhosis identified within the greater Metropolitan
Chicago area by query of the HealthLNK database. Methods:
HealthLNK captures over 2 million patients treated within
6 diverse healthcare integrated delivery networks in the greater
Chicago area (Northwestern Medicine, Univ of Chicago, Rush
Univ MC, University of Illinois of Chicago MC, and Loyola Univ
MC, and Cook County Health Systems) between 2006-2012.
Cirrhosis was defined by ICD-9 codes 571.2 OR 571.5 OR
571.6 OR Fib-4 score > 3.25. Demographics, and co-morbidities
assessed by ICD-9 codes, CPT codes, medications and laboratory
values were collected. Cirrhotic patients were stratified
into groups according to whether or not the MELD score was
measured. Comparisons by group were tested using t-tests or
chi-squared tests for continuous and non-continuous variables
respectively. Results: 24,185 cirrhotic patients were identified
and 11,481 (47%) had INR, bilirubin, and creatinine biochemistries
drawn at one or more points in time. There were no
differences in age or sex among those patients with no labs
available to calculate a MELD score versus those with labs to
calculate a MELD score (p2) were assimilated into
a screening tool. The tool was retrospectively applied to all
patients admitted to the Bristol Royal Infirmary with a diagnosis
of cirrhosis over 90 consecutive days from 1st July 2013
(n=54). Mortality 1 year post initial admission was calculated.
Results Of 54 index cases 7 were not analysed due to incompleteness
of data or loss to follow up. On the basis of optimum
sensitivity and specificity for death at 1 year a score of 3 or
more was considered a threshold for identifying likely poor
prognosis (table). Conclusions The tool has been trialed and
audited over the past year. Patients who screen positive (≥
3 criteria) are discussed at a weekly hepatology multidisciplinary
meeting (MDM). Assuming MDM agreement consultant
led patient discussion, a poor prognosis letter to the GP, and a
palliative medicine referral are triggered. Communication skills
training has been delivered to consultant and junior staff by
the palliative medicine team. As deaths from liver disease continue
to increase, identifying patients who stand to benefit from
advanced care planning and timely palliative care intervention
will become increasingly important.
Accuracy of tool at varying ‘thresholds’ for predicting mortality at
1 year
Disclosures:
The following authors have nothing to disclose: Benjamin E. Hudson, Kelly Ameneshoa,
Peter Collins, Andrew J. Portal, Fiona H. Gordon, Julia Verne, Anne
McCune
565
Distance to Transplant Center and Waiting List Outcomes
Jordan Voss, Adam McCann, Sean C. Kumer, Timothy Schmitt,
Richard Gilroy; Kansas University Medical Center, Kansas City, KS
Objective: To analyze the impact of a patient’s distance from
a transplant center on liver transplant waiting list outcomes.
Methods: All patients waitlisted at a single transplant center
from January, 2010 to May, 2014 were evaluated for waitlist
outcome, distance to transplant center and model for end-stage
liver disease (MELD) score at time of listing, transplant, and
death. Distance to transplant center was evaluated both as a
continuous variable and categorically for distances of 25, 50,
100, and 200 miles. Logistic regression was used to evaluate
the effect of distance on likelihood of death on the waiting list.
Results: 617 patients were waitlisted during the study period. In
univariate analysis distance was very weakly associated with a
lower MELD at both listing and death: R=-0.086, p=0.033 and
R=-0.181, p=0.036, respectively. Logistic regression revealed
that distance does not predict death on the waiting list (OR
1.000, p=0.851). Median test and Mann-Whitney U Test indicated
that MELD scores at listing, transplant, and death are
not significantly different among patients living within 25, 50,
100, and 200 miles of the transplant center compared to those
living outside the specified distances. Conclusions: A patient’s
distance from the liver transplant center does not appear to
impact MELD score at the time of listing and once listed does
not impact MELD at transplant/death or likelihood of death on
the waiting list. How socioeconomic and racial/ethnic variables
impact this warrants further consideration given the differ-