Real-world inpatient outcomes in Hispanic patients with primary HCC/biliary tract cancer: A retrospective cohort study of admission MELD-Na and hospital mortality, ICU use, and length of stay (2019–2025).

Abstract

e16303 Background: Hepatic reserve is a key determinant of outcomes in hospitalized hepatocellular carcinoma (HCC) and biliary tract cancers (BTC), yet inpatient risk stratification in Hispanic-majority settings is not well described. We evaluated whether liver function scores obtained at presentation predict in-hospital outcomes and resource utilization. Methods: We conducted a retrospective cohort study of adults admitted with primary HCC or BTC in Hispanic patients from January 2019 through December 2025. We excluded patients < 18 years, those with non-primary liver/biliary malignancy, emergency department visits with discharge, and patients who left against medical advice. For individuals with multiple admissions, only the earliest eligible hospitalization was included. Baseline laboratories were defined as the first values at presentation. MELD-Na and ALBI were calculated from admission data. The primary endpoint was in-hospital mortality; secondary endpoints included ICU admission and length of stay (LOS). Outcomes were compared across MELD-Na categories (< 15, 15–24, ≥25). Logistic regression evaluated the association between MELD-Na and in-hospital mortality with limited adjustment (age and sepsis). Predictive performance was assessed using ROC/AUC. Results: We included 125 patients (100% Hispanic; mean age 63.9 years; 36.8% female): 90 (72%) with HCC and 35 (28%) with BTC. ICU admission occurred in 37 (29.6%) and in-hospital mortality in 10 (8.0%); median LOS was 2 days. Mortality increased with MELD-Na: 0/66 (0%) for < 15, 2/36 (5.6%) for 15–24, and 8/23 (34.8%) for ≥25 (p < 0.001). ICU admission also increased across categories (15.2%, 38.9%, 56.5%; p < 0.001), with longer LOS (median 1, 3, and 4 days). In adjusted analysis, each 5-point increase in MELD-Na was associated with higher odds of in-hospital mortality (OR 2.47, 95% CI 1.58–3.86; p < 0.001). ROC analysis yielded AUC 0.947. As a secondary finding, ALBI grade 3 was associated with higher in-hospital mortality than grade 2 (19.1% vs 1.4%; p≈0.002). Conclusions: In this Hispanic patient cohort admitted with primary HCC/BTC, admission MELD-Na was associated with in-hospital mortality, ICU utilization, and LOS, and showed strong predictive performance for in-hospital mortality. Because MELD-Na is derived from routinely available admission laboratories, it may be useful for early inpatient risk stratification, resource planning, and timely goals-of-care discussions during hospitalization. These findings also support the applicability of MELD-Na–based risk assessment in Hispanic patients with hepatobiliary malignancies.