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

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

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

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

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

Generator type distribution between electro-surgery and PEAK PlasmaBlade^TM groups (matched groups).

<p>Generator type distribution between electro-surgery and PEAK PlasmaBlade^TM groups (matched groups).</p

Economic assessment of traditional surgical intervention versus use of a new innovative radiofrequency based surgical system in device replacements

<div><p>Introduction</p><p>Intra-operative complications like mechanical damages to the leads, infections and hematomas during generator replacements of implantable pacemakers and defibrillators contribute to additional costs for hospitals. The aim of this study was to evaluate operation room use, costs and budget impact of generator replacements using either a traditional surgical intervention (TSI) with scissors, scalpel and electrocautery vs. a new radiofrequency energy based surgical system, called PEAK PlasmaBlade^TM (PPB).</p><p>Materials and methods</p><p>We conducted a retrospective analysis of a population including 508 patients with TSI and 254 patients with PPB who underwent generator replacement at the Kepler University Hospital in Linz or the St. Josef Hospital in Braunau, Austria. The economic analysis included costs of resources used for intra-operative complications (lead damages) and of procedure time for TSI vs. PPB.</p><p>Results</p><p>Proportion of males, mean age and type of generator replaced were similar between the two groups. Lead damages occurred significantly more frequent with TSI than with PPB (5.3% and 0.4%; p< 0.001) and the procedure time was significantly longer with TSI than with PPB (47.9±24.9 and 34.1±18.1 minutes; p<0.001). Shorter procedure time and a lower rate of lead damages with PPB resulted in per patient cost savings of €81. Based on estimated 2,700 patients annually undergoing generator replacement in Austria, the use of PPB may translate into cost savings of €219,600 and 621 saved operating facility hours.</p><p>Conclusion</p><p>PPB has the potential to minimize the risk of lead damage with more efficient utilization of the operating room. Along with cost savings and improved quality of care, hospitals may use the saved operating room hours to increase the number of daily surgeries.</p></div