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Easy prognostic assessment of concomitant organ failure in critically ill patients undergoing mechanical ventilation

Published:October 09, 2019DOI:https://doi.org/10.1016/j.ejim.2019.09.002

      Highlights

      • MELD-XI is associated with mortality.
      • MELD-XI constitutes a useful tool for risk stratification in intensive care medicine.
      • Optimal MELD-XI cut-off is 12 for patients receiving mechanical ventilation.
      • MELD-XI provided information independently SAPS-2.
      • MELD-XI might find a role for early patient assessment due to its easy applicability.

      Abstract

      Background

      Acute respiratory distress syndrome (ARDS) is a life-threatening disease. We evaluated the prognostic utility of Model for End-stage Liver Disease excluding INR (MELD-XI) score for predicting mortality in a cohort of critically ill patients on mechanical ventilation.

      Methods

      In total, 11,091 mechanically ventilated patients were included in our post-hoc retrospective analysis, a subgroup of the VENTILA study (NCT02731898). Evaluation of associations with mortality was done by logistic and Cox regression analysis, an optimal cut-off was calculated using 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

      Peak-, plateau- and positive end-expiratory pressure were higher in patients with MELD-XI>12. Patients with MELD-XI>12 had higher driving pressures (14 ± 6 cmH2O versus 13 ± 6; p < 0.001). MELD-XI was associated with 28-day mortality after correction for relevant cofounders including SAPS II and ventilation pressures (HR 1.04 95%CI 1.03–1.05; p < 0.001. Patients with MELD-XI>12 evidenced both increased hospital (46% versus 27%; p < 0.001) and 28-day mortality (39% versus 22%).

      Conclusions

      MELD-XI is independently associated with mortality and constitutes a useful and easily applicable tool for risk stratification in critically ill patients receiving mechanical ventilation.
      Trial registration: NCT02731898, registered 4 April 2016.

      Abbreviations:

      MELD (Model for End-stage Liver Disease score), MELD-XI (MELD excluding INR), APACHE2 (Acute Physiology And Chronic Health Evaluation 2), ARDS (Acute Respiratory Distress Syndrome), ICU (Intensive Care Unit), PBW (Predicted Bodyweight), HR (Hazard Ratio), OR (Odds Ratio), 95%CI (95% Confidence Interval), AUC (Area Under the Curve)

      Keywords

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      Linked Article

      • Prognostication by concomitant organ failure in mechanically ventilated patients in ICU: Important issue to face with
        European Journal of Internal MedicineVol. 70
        • Preview
          Acute Physiology And Chronic Health Evaluation-2 (APACHE II) and Simplified Acute Physiology Score II (SAPS2) have been developed to assess the risk stratification of patients admitted to the intensive care unit (ICU) and are most commonly used so far. More recently, other simplified scores were tested including the Model for End-Stage Liver Disease (MELD), primarily developed in patients affected by liver disease [1], but subsequently validated as a marker of liver and kidney failure in subjects with multi-organ failure [2].
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