Mumtaz Score for Readmission in Cirrhosis

Mumtaz Calculator

MELD Score

Ascites at Discharge

Hepatic Encephalopathy

Previous Admissions (Past 6 Months)

Hyponatremia (Na <130 mEq/L)

Diabetes Mellitus

Mumtaz Score: –

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Predicts 30-day readmission risk in patients with cirrhosis.

Why Use

Designed specifically to predict 30-day readmission risk in decompensated cirrhosis. May help clinicians identify modifiable factors (e.g. social work support) at the time of discharge to prevent readmission.

When to Use

Patients >18 years old with decompensated cirrhosis at the time of discharge. Do not use in patients on mechanical ventilation, under palliative care consult, status post liver transplant, or those admitted electively for any reason.

Formula

Addition of the selected points: Variable Points Age, years 18-39 7 40-64 4 ≥65 0 Primary payer Medicare 4 Medicaid 5 Private insurance 0 Self-pay -3 No charge or other -1 Elixhauser Comorbidity Index* ≥3 2 <3 0 Non-alcoholic etiology of cirrhosis Yes 2 No 0 Ascites Yes 5 No 0 Hepatic encephalopathy Yes 4 No 0 Variceal bleeding Yes -7 No 0 Hepatocellular carcinoma Yes 3 No 0 Paracentesis during admission Yes 4 No 0 Hemodialysis during admission Yes 7 No 0 Disposition Routine 0 Transfer -1 Home health care 1 Against medical advice 10 *Elixhauser Comorbidity Index gives one point for each of the following (liver disease is excluded): Congestive heart failure C OPD Hypertension Obesity Diabetes, uncomplicated Diabetes with chronic complications Peripheral vascular disorders Metastatic cancer Solid tumor without metastasis Lymphoma Renal failure Alcohol abuse Drug abuse Valvular disease Paralysis Other neurological disorders Hypothyroidism Coagulopathy Peptic ulcer disease without bleeding Deficiency anemias Depression HIV/AIDS Rheumatoid arthritis/collagen vascular diseases Fluid and electrolyte disorders Psychoses Weight loss Chronic blood loss anemia Pulmonary circulation disorders

Pearls / Pitfalls

Scores range from -11 to +49, and higher scores suggest higher probability of readmission within 30 days. The score does not include lab values, unlike the MELD and Child-Pugh Scores . Based on administrative data. Not yet prospectively validated.

Management

High risk patients may benefit from the following: A TCM phone call or visit within 7 days about medications refill, adherence, and side effects. Social worker support for obtaining affordable medications. Discharge disposition with home health or skilled nursing facility. Comprehensive education for patient and families.

Critical Actions

Patients who decide to leave against medical advice should get their medications before they leave the hospital.

Advice

Careful discharge planning is advised for high risk patients with a focus on a proper transitional care management (TCM) system.

More Information

Interpretation: Mumtaz Score 30-day readmission risk Mumtaz Score 30-day readmission risk -11 9.3% 20 32.6% -10 9.7% 21 33.7% -9 10.2% 22 34.8% -8 10.6% 23 36.0% -7 11.1% 24 37.1% -6 11.6% 25 38.3% -5 12.2% 26 39.5% -4 12.7% 27 40.7% -3 13.3% 28 41.9% -2 13.9% 29 43.1% -1 14.5% 30 44.3% 0 15.1% 31 45.6% 1 15.7% 32 46.8% 2 16.4% 33 48.1% 3 17.1% 34 49.3% 4 17.8% 35 50.6% 5 18.6% 36 51.8% 6 19.4% 37 53.1% 7 20.1% 38 54.3% 8 21.0% 39 55.5% 9 21.8% 40 56.8% 10 22.7% 41 58.0% 11 23.6% 42 59.2% 12 24.5% 43 60.4% 13 25.4% 44 61.6% 14 26.4% 45 62.8% 15 27.3% 46 63.9% 16 28.3% 47 65.1% 17 29.4% 48 66.2% 18 30.4% 49 67.3% 19 31.5%