Easy prognostic assessment of concomitant organ failure in critically ill patients undergoing mechanical ventilation.

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.

• Authors: Bernhard Wernly, Fernando Frutos-Vivar, Oscar Peñuelas, Konstantinos Raymondos, Alfonso Muriel, Bin Du, Arnaud W Thille, Fernando Ríos, Marco González, Lorenzo Del-Sorbo, Maria Del Carmen Marín, Bruno Valle Pinheiro, Marco Antonio Soares, Nicolas Nin, Salvatore M Maggiore, Andrew Bersten, Malte Kelm, Pravin Amin, Nahit Cakar, Michael Lichtenauer, Gee Young Suh, Fekri Abroug, Manuel Jibaja, Dimitros Matamis, Amine Ali Zeggwagh, Yuda Sutherasan, Antonio Anzueto, Andrés Esteban, Christian Jung
• Journal: European journal of internal medicine (Eur J Intern Med) Vol. 70 Pg. 18-23 (Dec 2019) ISSN: 1879-0828 [Electronic] Netherlands
• PMID: 31606309 (Publication Type: Journal Article, Multicenter Study, Observational Study)
• Copyright: Copyright © 2019 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

Topics

• Adult
• Aged
• Critical Illness (therapy)
• End Stage Liver Disease (complications, mortality)
• Female
• Hemodynamics
• Hospital Mortality
• Humans
• International Normalized Ratio
• Male
• Middle Aged
• Multivariate Analysis
• Prognosis
• Respiration, Artificial
• Retrospective Studies
• Risk Assessment
• Severity of Illness Index
• Survival Analysis