Persistent ascites and low serum sodium identify patients with cirrhosis and low MELD scores who are at high risk for early death

Despite the adoption of “sickest first” liver transplantation, pretransplant death remains common, and many early deaths occur despite initially low Model for End‐stage Liver Disease (MELD) scores. From 1997–2003, we studied 507 cirrhotic United States veterans referred for consideration of liver transplantation to identify additional predictors of early mortality. Most of the patients were male (98%) with cirrhosis caused by hepatitis C and/or alcohol (88%). Data for 296 patients referred prior to February 27, 2002 (training group), were analyzed; findings were validated in 211 patients referred subsequently (validation group). In the training group, 61 patients (21%) died within 180 days without transplantation; their median initial MELD score was 21. MELD score, persistent ascites, and low serum sodium (