Highlights
- •MELD-XI is associated with in-hospital mortality.
- •MELD-XI constitutes a useful tool for risk stratification in intensive care.
- •Optimal cut-off of 12 score points for prediction of in-hospital mortality
- •No associations between MELD-XI and microcirculation
- •No association of microcirculation and mortality
Abstract
Purpose
We aimed (i) to evaluate Model for End-stage Liver Disease excluding INR (MELD-XI)
score for prediction of mortality in a cohort of critically ill patients and (ii)
to investigate associations of MELD-XI with microcirculation and (iii) to evaluate
microcirculation for prediction of mortality in high-risk patients, e.g., with high
MELD-XI scores.
Methods
308 patients were included in our retrospective analysis, a subgroup of the multicenter
micro-SOAP-study. Microcirculation was evaluated by Sidestream Dark Field (SDF) imaging.
Evaluation of associations with mortality was done by logistic regression analysis,
an optimal cut-off was calculated by means of the Youden Index. We divided the cohort
in two sub-groups based on their MELD-XI score at the optimal cut-off (12 score points).
Results
Patients with a MELD-XI > 12 points were of similar age (60 ± 1 years vs 62 ± 2 years;
p = 0.32), but clinically sicker as mirrored by higher APACHE II scores (20 ± 1 vs
16 ± 1; p < 0.001). In the MELD-XI > 12 cohort in-hospital mortality was significantly
higher compared to the MELD ≤ 12 group (48% vs 24%%; HR 2.98 95%CI 1.76–5.04; p = 0.003)
and MELD-XI score was associated with mortality even after correction for relevant
clinical confounders (HR 1.04 95%CI 1.01–1.07; p = 0.004) There were no associations
between MELD-XI and parameters of microvascular perfusion.
Conclusions
MELD-XI is associated with in-hospital mortality and constitutes a useful tool for
risk stratification in intensive care medicine. Interestingly, there were no associations
between MELD-XI and microcirculation. Possibly parameters of the microcirculation
present an online tool of hemodynamic assessment while MELD-XI presents an assessment
of already established organ failure.
Keywords
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Article info
Publication history
Published online: March 22, 2018
Accepted:
January 29,
2018
Received in revised form:
January 10,
2018
Received:
July 14,
2017
Identification
Copyright
© 2018 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
