Bernhard Wernly1, Fernando Frutos-Vivar2, Oscar Peñuelas3, Konstantinos Raymondos4, Alfonso Muriel5, Bin Du6, Arnaud W Thille7, Fernando Ríos8, Marco González9, Lorenzo Del-Sorbo10, Maria Del Carmen Marín11, Bruno Valle Pinheiro12, Marco Antonio Soares13, Nicolas Nin14, Salvatore M Maggiore15, Andrew Bersten16, Malte Kelm17, Pravin Amin18, Nahit Cakar19, Michael Lichtenauer20, Gee Young Suh21, Fekri Abroug22, Manuel Jibaja23, Dimitros Matamis24, Amine Ali Zeggwagh25, Yuda Sutherasan26, Antonio Anzueto27, Andrés Esteban28, Christian Jung29. 1. Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, Salzburg 5020, Austria. Electronic address: bernhard@wernly.at. 2. Hospital Universitario de Getafe & Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Spain. Electronic address: ffrutos@ucigetafe.com. 3. Hospital Universitario de Getafe & Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Spain. 4. Medizinische Hochschule Hannover, Germany. Electronic address: Raymondos.Konstantinos@mh-hannover.de. 5. Hospital Universitario de Getafe & Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Spain; Unidad de Bioestadística Clinica Hospital Ramón y Cajal, Instituto Ramón y Cajal de Investigaciones Sanitarias (IRYCIS) & Centro de Investigación en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain. Electronic address: alfonso.muriel@hrc.es. 6. Peking Union Medical College Hospital, Beijing, PR China. 7. University Hospital of Poitiers, Poitiers, France. 8. Hospital Nacional Alejandro Posadas, Buenos Aires, Argentina. 9. Clínica Medellín & Universidad Pontificia Bolivariana, Medellín, Colombia. 10. Interdepartmental Division of Critical Care Medicine, Toronto, ON, Canada. Electronic address: Lorenzo.delSorbo@uhn.ca. 11. Hospital Regional 1° de Octubre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), México, DF, Mexico. 12. Pulmonary Research Laboratory, Federal University of Juiz de Fora, Brazil. 13. Hospital Universitario Sao Jose, Belo Horizonte, Brazil. 14. Hospital Español, Montevideo, Uruguay. 15. Università degli Studi G. d'Annunzio Chieti e Pescara, Italy. Electronic address: salvatore.maggiore@unich.it. 16. Department of Critical Care Medicine, Flinders University, Adelaide, South Australia, Australia. Electronic address: andrew.bersten@flinders.edu.au. 17. Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University of Düsseldorf, Düsseldorf 40225, Germany. Electronic address: malte.kelm@med.uni-duesseldorf.de. 18. Bombay Hospital Institute of Medical Sciences, Mumbai, India. Electronic address: pamin@vsnl.com. 19. Department of Anesthesiology and Reanimation, Koç University Faculty of Medicine, İstanbul-Turkey. 20. Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, Salzburg 5020, Austria. Electronic address: m.lichtenauer@salk.at. 21. Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. 22. Hospital Fattouma Bourguina, Monastir, Tunisia. Electronic address: f.abroug@rns.tn. 23. Unidad de Cuidados Intensivos, Hospital Eugenio Espejo, Escuela de Medicina, Universidad Internacional del Ecuador, Quito. 24. Papageorgiou Hospital, Thessaloniki, Greece. 25. Centre Hospitalier Universitarie Ibn Sina, Mohammed V University, Rabat, Morocco. Electronic address: aazeggwagh@invivo.edu. 26. Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. 27. Division of Pulmonary Diseases & Critical Care Medicine, The University of Texas Health Science Centre at San Antonio, San Antonio, TX, USA. Electronic address: anzueto@uthscsa.edu. 28. Hospital Universitario de Getafe & Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Spain. Electronic address: aesteban@ucigetafe.com. 29. Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University of Düsseldorf, Düsseldorf 40225, Germany. Electronic address: Christian.Jung@med.uni-duesseldorf.de.
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.
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 illpatients 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 illpatients receiving mechanical ventilation. TRIAL REGISTRATION: NCT02731898, registered 4 April 2016.