Model of End-Stage Liver Disease (MELD) Score as a Predictor of In-Hospital Mortality in Patients with COVID-19: A Novel Approach to a Classic Scoring System

Stawinski, Peter; Dziadkowiec, Karolina N.; Al-Abbasi, Baher; Suarez, Laura; Simms, Larnelle N.; Dewaswala, Nakeya; Torres, Pedro Iturralde; Rubaye, Ayat Al; Pino, Jesus; Marcus, Akiva

doi:10.7759/cureus.15179

Cited by 12 publications

(13 citation statements)

References 21 publications

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“…It has been hypothesized earlier in the pandemic that patients taking ACE inhibitors or angiotensin receptor blockers would be at a higher risk of adverse clinical outcomes; however, later studies have refuted this hypothesis [17,18]. In addition, COVID-19 is associated with myocardial injury [19,20], thrombocytopenia [21,22], and liver dysfunction [23][24][25][26][27] which predicts higher mortality in the general population and in patients with HF [28,29].…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Heart Failure in COVID-19 Patients: An Appalachian Experience

et al. 2022

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Background The Southeastern rural areas of the USA have a higher prevalence of heart failure (HF). Coronavirus disease 2019 (COVID-19) infection is associated with poor outcomes in patients with HF. Our study aimed to compare the outcomes of hospitalized HF patients with and without COVID-19 infection specifically in rural parts of the USA. Methods We conducted a retrospective cohort study of HF patients with and without COVID-19 hospitalized in Southeastern rural parts of the USA by using the Appalachian Regional Healthcare System. Analyses were stratified by waves from April 1, 2020 to May 31, 2021, and from June 1, 2021 to October 19, 2021. Results Of the 14,379 patients hospitalized with HF, 6% had concomitant COVID-19 infection. We found that HF patients with COVID-19 had higher mortality rate compared to those without COVID-19 (21.8% versus 3.8%, respectively, P < 0.01). Additionally, hospital resource utilization was significantly higher in HF patients with COVID-19 compared to HF patients without COVID-19 with intensive care unit (ICU) utilization of 21.6% versus 13.8%, P < 0.01, mechanical ventilation use of 17.3% versus 6.2%, P < 0.01, and vasopressor/inotrope use of 16.8% versus 7.9%, P < 0.01. A lower percentage of those with COVID-19 were discharged home compared to those without a COVID-19 diagnosis (63.4% versus 72.0%, respectively). There was a six-fold greater odds of dying in the first wave and seven-fold greater odds of dying in the second wave. Conclusions Our study confirms previous findings of poor outcome in HF patients with COVID-19. There is a need for review of healthcare resources in rural hospitals which already face numerous healthcare challenges.

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Section: Discussionmentioning

confidence: 99%

Outcomes of Heart Failure in COVID-19 Patients: An Appalachian Experience

et al. 2022

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“…Additional laboratory abnormalities, such as neutrophil-to-lymphocyte ratio, troponin-I, and abnormal liver function tests, have also been associated with increased mortality and adverse outcomes, which can be further explored in future studies. 22–27 …”

Section: Discussionmentioning

confidence: 99%

Predictors of Mortality for Patients with COVID-19 in the Rural Appalachian Region

Bhopalwala¹,

Dewaswala²,

Kolagatla³

et al. 2022

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Background The prevalence and outcome of coronavirus disease 2019 (COVID-19) in rural areas is unknown. Methods This is a multi-center retrospective cohort study of hospitalized patients diagnosed with COVID-19 from April 5, 2020 to December 31, 2020. The data were extracted from 13 facilities in the Appalachian Regional Healthcare system that share the same electronic health record using ICD-10-CM codes. Results The number of patients diagnosed with COVID-19 per facility ranged from 5 to 535 with a median of 106 patients. Total mortality was 11.4% and ranged from 0% to 22.6% by facility (median: 9.0%). Non-survivors had a greater prevalence of congestive heart failure (CHF), hypertension, type 2 diabetes mellitus, stroke, transient ischemic attack (TIA), and pulmonary embolism. Patients who died were also more likely to have had chronic obstructive pulmonary disease (COPD), acute respiratory failure (ARF), liver cirrhosis, chronic kidney disease (CKD), dementia, cancer, anemia, and opiate dependence. Conclusion The aging population, multiple co-morbidities, and health-related behaviors make rural patients vulnerable to COVID-19. A better understanding of the disease in rural areas is crucial, given its heightened vulnerability to adverse outcomes.

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“…While our study was conducted, few studies were had already evaluated the relationship between in-hospital (short-term) mortality o, length of intensive care, length of hospital stay, and long-term mortality of COVID-19 and the MELD-XI score [26][27] . In one of these studies, a higher MELD-XI score was found to be associated with mortality in COVID-19 patients without liver disease, and it was stated that it could be a helpful tool for other risk modalities 26 . In another study, it was shown that the MELD-XI score may be useful in predicting early mortality in the elderly and critically ill patients 27 .…”

Section: Discussionmentioning

confidence: 99%

Comparison of inflammation-based parameters and MELD-XI score with 4C mortality score in predicting in-hospital mortality in COVID-19

ÇELİK

Çiftci

Özer

et al. 2022

Cukurova Medical Journal

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Purpose: In this study, we compared the roles of inflammatory parameters such as neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), C-reactive protein/lymphocyte ratio (CLR), monocyte/lymphocyte ratio (MLR), neutrophil/platelet ratio (NPR), neutrophil/monocyte ratio (NMR), CRP/albumin ratio (CAR), BUN/albumin ratio (BAR), MELD-XI score and 4C mortality score in predicting in-hospital mortality risk in COVID-19. Materials and Methods: A total of 117 patients over 18 years old with a PCR-confirmed diagnosis of COVID-19 between June 2020 and February 2021 were retrospectively included. The roles of parameters for independently predicting in-hospital mortality were determined and compared with each other using appropriate statistical methods. Results: Age, chronic kidney disease, diabetes mellitus, acute kidney injury, and length of hospital stay, urea, creatinine, LDH, AST, ferritin, D-dimer, CRP, albumin, Hb, CLR, BAR, CAR, MELD-XI score, and 4C mortality score were significantly correlated to in-hospital mortality. However, only the 4C mortality score and AST independently predicted in-hospital mortality in COVID-19 [OR 2.08 (%95 CI 1.06-2.36), for 4C mortality score, and OR 1.05 (%95 CI 1.00-1.10), for AST]. Conclusion: Unlike other mortality-related inflammatory parameters, the 4C mortality score and AST were independent and strong predictors of mortality in hospitalized COVID-19 patients.

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Model of End-Stage Liver Disease (MELD) Score as a Predictor of In-Hospital Mortality in Patients with COVID-19: A Novel Approach to a Classic Scoring System

Cited by 12 publications

References 21 publications

Outcomes of Heart Failure in COVID-19 Patients: An Appalachian Experience

Outcomes of Heart Failure in COVID-19 Patients: An Appalachian Experience

Predictors of Mortality for Patients with COVID-19 in the Rural Appalachian Region

Comparison of inflammation-based parameters and MELD-XI score with 4C mortality score in predicting in-hospital mortality in COVID-19

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