Preoperative hepatic dysfunction could predict postoperative mortality and morbidity in patients undergoing cardiac surgery: Utilization of the MELD scoring system

Murata, Mai; Kato, Tomoko S.; Kuwaki, Kenji; Yamamoto, Taira; Dohi, Shizuyuki; Amano, Atsushi

doi:10.1016/j.ijcard.2015.10.181

Cited by 38 publications

(34 citation statements)

References 35 publications

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“…By means of the Youden-Index we calculated an optimal cut-off value for our study population. This MELD-XI score value was 11 and therewith only slightly lower compared to the value of 12 as calculated in previously published studies [ 21 , 22 ]. Interestingly, an optimal cut-off varied remarkably depending on the admission diagnosis.…”

Section: Resultscontrasting

confidence: 41%

Model for End-stage Liver Disease excluding INR (MELD-XI) score in critically ill patients: Easily available and of prognostic relevance

et al. 2017

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PurposeMELD-XI, an adapted version of Model for End-stage Liver Disease (MELD) score excluding INR, was reported to predict outcomes e.g. in patients with acute heart failure. We aimed to evaluate MELD-XI in critically ill patients admitted to an intensive care unit (ICU) for prognostic relevance.MethodsA total of 4381 medical patients (66±14 years, 2862 male) admitted to a German ICU between 2004 and 2009 were included and retrospectively investigated. Admission diagnoses were e.g. myocardial infarction (n = 2034), sepsis (n = 694) and heart failure (n = 688). We divided our patients in two cohorts basing on their MELD-XI score and evaluated the MELD-XI score for its prognostic relevance regarding short-term and long-term survival. Optimal cut-offs were calculated by means of the Youden-Index.ResultsPatients with a MELD-XI score >12 had pronounced laboratory signs of organ failure and more comorbidities.MELD-XI >12 was associated with an increase in short-term (27% vs 6%; HR 4.82, 95%CI 3.93–5.93; p<0.001) and long-term (HR 3.69, 95%CI 3.20–4.25; p<0.001) mortality. In a univariate Cox regression analysis for all patients MELD-XI was associated with increased long-term mortality (changes per score point: HR 1.06, 95%CI 1.05–1.07; p<0.001) and remained to be associated with increased mortality after correction in a multivariate regression analysis for renal failure, liver failure, lactate concentration, blood glucose concentration, oxygenation and white blood count (HR 1.04, 95%CI 1.03–1.06; p<0.001). Optimal cut-off for the overall cohort was 11 and varied remarkably depending on the admission diagnosis: myocardial infarction (9), pulmonary embolism (9), cardiopulmonary resuscitation (17) and pneumonia (17). We performed ROC-analysis and compared the AUC: SAPS2 (0.78, 95%CI 0.76–0.80; p<0.0001) and APACHE (0.76, 95%CI 0.74–0.78; p<0.003) score were superior to MELD-XI (0.71, 95%CI 0.68–0.73) for prediction of mortality.ConclusionsThe easily calculable MELD-XI score is a robust and reliable tool to predict both intra-ICU and long-term mortality in critically ill medical patients admitted to an ICU. Optimal cut-off values for MELD-XI scores seem to depend on the primary disease and need to be validated in future prospective studies. Compared to SAPS2 and APACHE score, MELD-XI lacks precision but might have comparable and even additive value, as it is easily available and independent of subjective values.

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Section: Resultscontrasting

confidence: 41%

Model for End-stage Liver Disease excluding INR (MELD-XI) score in critically ill patients: Easily available and of prognostic relevance

et al. 2017

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“…Sern Lim 28 found remarkably similar results in a cohort of 26 patients undergoing VA‐ECMO as bridge to transplantation; 69% mortality for patients with a baseline MELD‐XI of 14 or greater compared to 31% for those with a baseline MELD‐XI less than 14. Among all the literature that investigates MELD‐XI in regard to cardiac disease processes, the cutoff value used to define the high‐risk cohort ranged from 10 to 15 11‐26,28 . In our study, the optimal cutoff based on the Youden index was 12.98 and a cutoff of 14 demonstrated significant prognostic value (odds ratio, 4.75; P < .001).…”

Section: Resultsmentioning

confidence: 70%

“…The MELD‐XI score, originally developed to account for the frequent anticoagulation use among cirrhotic patients awaiting transplant, 10 has shown clinical prognostic utility for a number of cardiac disease processes 11‐25 . It is an objective measure that requires only creatinine and total bilirubin values, making it accessible and easy to implement in a clinical setting.…”

Section: Resultsmentioning

confidence: 99%

MELD‐XI is predictive of mortality in venoarterial extracorporeal membrane oxygenation

et al. 2020

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Background Venoarterial extracorporeal membrane oxygenation (VA‐ECMO) is a life‐saving method of supporting critically ill patients. However, it is expensive and associated with high morbidity and mortality, making early predictive outcome modeling extremely valuable. The model for end‐stage liver disease‐excluding international normalized ratio (MELD‐XI) scoring system has been shown to have prognostic value in other critically ill patient populations. Materials and Methods A single‐center retrospective review was performed for all adult patients managed on VA‐ECMO from May 2011 to January 2018 (n = 247). Patients were included in the study if MELD‐XI scores could be calculated during the first 48 hours on ECMO (n = 187). Receiver operating characteristic curve analysis was performed for MELD‐XI in regard to in‐hospital mortality. Results Of the 187 patients, 74 (40%) patients had MELD‐XI less than 14 (low‐risk) and 113 (60%) had a MELD‐XI of 14 or greater (high‐risk). The cohorts did not differ significantly in terms of patient characteristics or indication for ECMO. The high‐risk MELD‐XI group had significantly greater mortality during index hospitalization compared to the low‐risk group (74% vs 39%; P < .0001). Quartile stratification demonstrated progressively worse prognosis associated with higher MELD‐XI scores; the fourth quartile showed a ninefold increased risk of mortality compared to the first quartile (P < .001). The AUC for predicting index hospitalization mortality was 0.69 (95% CI, 0.62‐0.77) with a Youden index (J) of 0.36 and optimized cutoff of 12.98. Conclusions These findings suggest that the MELD‐XI scoring system can be applied to the VA‐ECMO patient population early in their course of ECMO as a prognostic tool to aid in complex clinical decision making.

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“…The MELD score, which re ects liver and kidney function (based on total bilirubin, creatinine, and the INR), was developed to assess risk in patients with liver cirrhosis [22]. Recent studies have shown that the MELD score has prognostic value for cardiovascular diseases and several cardiac surgeries and interventions, including heart transplantation [12,23,24]. Atrial brillation is a highly prevalent comorbidity of cardiovascular disease, and treatment frequently includes anticoagulants [25].…”

Section: Discussionmentioning

confidence: 99%

MELD-Albumin score predicts 30-day mortality in high-risk patients with acute pulmonary embolism admitted to intensive care units

İdin¹,

Dereli²,

Yenerçağ³

et al. 2020

Preprint

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Background: The Model for End-stage Liver Disease excluding the international normalised ratio (INR, MELD-XI) and modified MELD, which uses albumin in place of the INR (MELD-Albumin) scores reflect liver and renal function and are predictors of mortality. However, their prognostic value in acute pulmonary embolism (APE) has not been studied.Methods: We assessed the predictive value of the MELD scores in patients diagnosed with high-risk APE admitted to the intensive care unit (ICU). The primary outcome was 30-day mortality.Results: Of the 273 patients included in the study, 231 were survivors and 42 were non-survivors. The mortality rate was 15.3%. The mean Meld-XI and MELD-Albumin scores were significantly higher in the non-survivors than in the survivors (MELD XI, 11.8 ± 1.8 and 10.6 ± 1.43, respectively; p = 0.002; MELD-Albumin, 10.5 ± 1.6 and 8.7 ± 1.1, respectively; p = 0.001). The multiple logistic regression analysis identified the MELD-XI (hazard ratio [HR]: 3.029, confidence interval [CI]: 1.06–1.21, p = 0.007) and MELD-Albumin (HR: 1.13, CI: 1.06–1.21, p = 0.002) scores as independent predictors of mortality. Receiver operating characteristic analysis revealed that the predictive power of the MELD-Albumin score (0.871 ± 0.014; p < 0.001) was higher than those of the MELD-XI (0.726 ± 0.022, p < 0.001), APACHE III (0.682 ± 0.024, p < 0.001), and PESI (0.624 ± 0.023, p < 0.001) scores.Conclusions: The MELD-Albumin score is an easily calculable, reliable, and practical risk assessment tool and independent predictor of 30-day mortality in patients with high-risk APE.

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Preoperative hepatic dysfunction could predict postoperative mortality and morbidity in patients undergoing cardiac surgery: Utilization of the MELD scoring system

Cited by 38 publications

References 35 publications

Model for End-stage Liver Disease excluding INR (MELD-XI) score in critically ill patients: Easily available and of prognostic relevance

Model for End-stage Liver Disease excluding INR (MELD-XI) score in critically ill patients: Easily available and of prognostic relevance

MELD‐XI is predictive of mortality in venoarterial extracorporeal membrane oxygenation

MELD-Albumin score predicts 30-day mortality in high-risk patients with acute pulmonary embolism admitted to intensive care units

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