Thoetchai Peeraphatdit1, Niyada Naksuk2, Charat Thongprayoon3, William S Harmsen4, Terry M Therneau4, Paola Ricci5, Lewis R Roberts6, Roongruedee Chaiteerakij7. 1. Department of Internal Medicine, University of Minnesota, Minneapolis, MN; Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN. 2. Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN. 3. Department of Anesthesiology, Mayo Clinic, Rochester, MN. 4. Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN. 5. Division of Gastroenterology, Minneapolis Veterans Affairs Health Care System, Minneapolis. 6. Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN. Electronic address: roberts.lewis@mayo.edu. 7. Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN; Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
Abstract
OBJECTIVE: To determine whether daily measurement of Model for End-Stage Liver Disease (MELD) score adds prognostic value to the initial MELD score in predicting mortality among patients with cirrhosis admitted to the intensive care unit (ICU). METHODS: We included 830 consecutive patients with cirrhosis admitted to a tertiary care ICU from January 1, 2003, through December 31, 2013, who had MELD scores on admission day 1 (MELD-D1). Daily MELD score during the first 7 days of ICU admission were retrospectively abstracted. The performances of MELD-D1 to MELD-D7 and changes in MELD score on consecutive days (Δ-MELD) in predicting 90-day mortality were determined using logistic regression. RESULTS: MELD-D1 was an independent predictor of mortality (adjusted odds ratio, 1.07; 95% CI, 1.05-1.10; P<.001), with an area under the receiver operating characteristic curve (AUC) of 0.72. MELD-D2 to MELD-D7 yielded comparable performance to MELD-D1 with an approximately 10% increase in risk of death per each incremental unit of MELD score (odds ratios, 1.09-1.11; P<.001; AUCs, 0.68-0.72). Δ-MELD-D2 to Δ-MELD-D7 were not independently associated with mortality (P=.69, P=.42, P=.81, P=.94, P=.83 and P=.28, respectively) and did not increase the predictive performance (AUCs) when combined with MELD-D2 to MELD-D7. CONCLUSION: Repeating MELD score assessment during the first 7 days after ICU admission does not improve the ability of the initial MELD score for predicting 90-day mortality among patients with cirrhosis. Our finding does not support the practice of routine daily measurement of the MELD score.
OBJECTIVE: To determine whether daily measurement of Model for End-Stage Liver Disease (MELD) score adds prognostic value to the initial MELD score in predicting mortality among patients with cirrhosis admitted to the intensive care unit (ICU). METHODS: We included 830 consecutive patients with cirrhosis admitted to a tertiary care ICU from January 1, 2003, through December 31, 2013, who had MELD scores on admission day 1 (MELD-D1). Daily MELD score during the first 7 days of ICU admission were retrospectively abstracted. The performances of MELD-D1 to MELD-D7 and changes in MELD score on consecutive days (Δ-MELD) in predicting 90-day mortality were determined using logistic regression. RESULTS: MELD-D1 was an independent predictor of mortality (adjusted odds ratio, 1.07; 95% CI, 1.05-1.10; P<.001), with an area under the receiver operating characteristic curve (AUC) of 0.72. MELD-D2 to MELD-D7 yielded comparable performance to MELD-D1 with an approximately 10% increase in risk of death per each incremental unit of MELD score (odds ratios, 1.09-1.11; P<.001; AUCs, 0.68-0.72). Δ-MELD-D2 to Δ-MELD-D7 were not independently associated with mortality (P=.69, P=.42, P=.81, P=.94, P=.83 and P=.28, respectively) and did not increase the predictive performance (AUCs) when combined with MELD-D2 to MELD-D7. CONCLUSION:Repeating MELD score assessment during the first 7 days after ICU admission does not improve the ability of the initial MELD score for predicting 90-day mortality among patients with cirrhosis. Our finding does not support the practice of routine daily measurement of the MELD score.
Authors: J L Vincent; R Moreno; J Takala; S Willatts; A De Mendonça; H Bruining; C K Reinhart; P M Suter; L G Thijs Journal: Intensive Care Med Date: 1996-07 Impact factor: 17.440
Authors: W A Knaus; D P Wagner; E A Draper; J E Zimmerman; M Bergner; P G Bastos; C A Sirio; D J Murphy; T Lotring; A Damiano Journal: Chest Date: 1991-12 Impact factor: 9.410
Authors: Russell Wiesner; Erick Edwards; Richard Freeman; Ann Harper; Ray Kim; Patrick Kamath; Walter Kremers; John Lake; Todd Howard; Robert M Merion; Robert A Wolfe; Ruud Krom Journal: Gastroenterology Date: 2003-01 Impact factor: 22.682