A high MELD-XI score identified sicker patients with multiple preconditions.

<p>Normally distributed data points are expressed as mean ± standard deviation.</p

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

<div><p>Purpose</p><p>MELD-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.</p><p>Methods</p><p>A 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.</p><p>Results</p><p>Patients with a MELD-XI score >12 had pronounced laboratory signs of organ failure and more comorbidities.</p><p>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.</p><p>Conclusions</p><p>The 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.</p></div

A high MELD-XI score identified sicker patients with multiple preconditions.

<p>Normally distributed data points are expressed as mean ± standard deviation.</p

Baseline characteristics of the study population.

<p>Patients with a MELD-XI score above 12 were older (68 ± 13 years vs 65 ± 14 years; p<0.001), had higher lactate levels at admission (2.6 /L ± 4.2 mmol/L vs 2.0 ± 2.8 mmol/L; p<0.001) and had more pronounced laboratory signs of organ failure. Normally distributed data points are expressed as mean ± standard deviation.</p

A MELD-XI >12 predicted increased intra-ICU mortality regardless of primary/secondary diagnosis.

<p>A MELD-XI >12 predicted increased intra-ICU mortality regardless of primary/secondary diagnosis.</p

In a Cox regression analysis MELD-XI (changes per unit in points) was associated with increased long-term mortality regardless of admission diagnosis.

<p>In a Cox regression analysis MELD-XI (changes per unit in points) was associated with increased long-term mortality regardless of admission diagnosis.</p

Patients with a MELD-XI >12 at admission showed significantly increased long-term mortality (HR 3.69, 95%CI 3.20–4.25; p<0.001).

<p>Patients with a MELD-XI >12 at admission showed significantly increased long-term mortality (HR 3.69, 95%CI 3.20–4.25; p<0.001).</p

Comparison of MELD-XI score to APACHE and SAPS2 scores: ROC—analysis was performed and AUC calculated.

<p>Comparison of MELD-XI score to APACHE and SAPS2 scores: ROC—analysis was performed and AUC calculated.</p

Higher admission BUN levels are associated with adverse in-hospital outcome.

<p>Hazard ratios (HR) were obtained by logistic regression analysis.</p

Higher admission BUN levels are associated with adverse long-term outcome, depicted as Kaplan-Meier curve, group comparison by log-rank test, p-value <0.001.

<p>Higher admission BUN levels are associated with adverse long-term outcome, depicted as Kaplan-Meier curve, group comparison by log-rank test, p-value <0.001.</p