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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References
- A new simplified acute physiology score (SAPS II) based on a European/North American multicenter study.JAMA. 1993; 270: 2957-2963
- APACHE-acute physiology and chronic health evaluation: a physiologically based classification system.Crit Care Med. 1981; 9: 591-597
- A systematic review of the performance of the model for end-stage liver disease (MELD) in the setting of liver transplantation.Liver Transpl. 2006; 12: 1049-1061
- Assessment of adult patients with chronic liver failure for liver transplantation in 2015: who and when?.Intern Med J. 2016; 46: 404-412
- The model for end-stage liver disease (MELD).Hepatology. 2007; 45: 797-805
- Model for End-stage Liver Disease excluding INR (MELD-XI) score in critically ill patients: Easily available and of prognostic relevance.PLoS One. 2017; 12e0170987
- Predicting short- and long-term outcomes in adult heart transplantation: clinical utility of MELD-XI score.Transplant Proc. 2018; 50: 3710-3714
- Prognostic value of impaired hepato-renal function assessed by the MELD-XI score in patients undergoing percutaneous mitral valve repair.Catheter Cardiovasc Interv. 2019; 93: 699-706
- Model for End-Stage Liver Disease Excluding INR (MELD-XI) score is associated with hemodynamic impairment and predicts mortality in critically ill patients.Eur J Intern Med. 2018; 51: 80-84
- Experimental pulmonary edema due to intermittent positive pressure ventilation with high inflation pressures. Protection by positive end-expiratory pressure.Am Rev Respir Dis. 1974; 110: 556-565
- High inflation pressure pulmonary edema. Respective effects of high airway pressure, high tidal volume, and positive end-expiratory pressure.Am Rev Respir Dis. 1988; 137: 1159-1164
- Adverse effects of large tidal volume and low PEEP in canine acid aspiration.Am Rev Respir Dis. 1990; 142: 311-315
- Low mortality associated with low volume pressure limited ventilation with permissive hypercapnia in severe adult respiratory distress syndrome.Intensive Care Med. 1990; 16: 372-377
- Characteristics and outcomes in adult patients receiving mechanical ventilation: A 28-day international study.JAMA. 2002; 287: 345-355
- Lactate clearance predicts good neurological outcomes in cardiac arrest patients treated with extracorporeal cardiopulmonary resuscitation.J Clin Med. 2019; 8
- Prognostic relevance of serum lactate kinetics in critically ill patients.Intensive Care Med. 2019; 45: 55-61
- Risk prediction in infective endocarditis by modified MELD-XI score.Eur J Clin Microbiol Infect Dis. 2018; 37: 1243-1250
- Prognostic value of liver dysfunction assessed by MELD-XI scoring system in patients undergoing transcatheter aortic valve implantation.Int J Cardiol. 2017; 228: 648-653
- Prognostic value of chronic kidney disease after transcatheter aortic valve implantation.J Am Coll Cardiol. 2013; 62: 869-877
- Liver function abnormalities and outcome in patients with chronic heart failure: Data from the Candesartan in Heart Failure: Assessment of Reduction in Mortality and Morbidity (CHARM) program.Eur J Heart Fail. 2009; 11: 170-177
- Liver function abnormalities, clinical profile, and outcome in acute decompensated heart failure.Eur Heart J. 2013; 34: 742-749
Article info
Publication history
Published online: October 09, 2019
Accepted:
September 2,
2019
Received in revised form:
August 25,
2019
Received:
August 1,
2019
Identification
Copyright
© 2019 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
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Access this article on ScienceDirectLinked Article
- Prognostication by concomitant organ failure in mechanically ventilated patients in ICU: Important issue to face withEuropean Journal of Internal MedicineVol. 70
- PreviewAcute 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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