Association of Model for End-Stage Liver Disease Score and Mortality in Trauma Patients With Chronic Liver Disease. JAMA Surg 2016 Jan;151(1):41-8
Date
10/01/2015Pubmed ID
26422817DOI
10.1001/jamasurg.2015.3114Scopus ID
2-s2.0-84955302267 (requires institutional sign-in at Scopus site) 7 CitationsAbstract
IMPORTANCE: The Model for End-Stage Liver Disease (MELD) score is predictive of trauma outcomes.
OBJECTIVE: To determine whether a decrease in MELD score is associated with improved mortality in critically ill trauma patients.
DESIGN, SETTING, AND PARTICIPANTS: We performed a retrospective registry study of critically ill trauma patients 18 years or older with chronic liver disease treated between August 3, 1998, and January 5, 2012, at 2 level I trauma centers in Boston, Massachusetts. The consecutive sample included 525 patients (male, 373 [71.0%]; white, 399 [76.0%]; mean [SD] age, 55.0 [12.4] years).
EXPOSURES: Change in MELD score from intensive care unit (ICU) admission to 48 to 72 hours later.
MAIN OUTCOMES AND MEASURES: Thirty-day all-cause mortality.
RESULTS: The mean (SD) MELD score at ICU admission was 19.3 (9.7). The 30-day mortality was 21.9%. The odds of 30-day mortality with a change in MELD score of less than -2, -2 to -1, +1 to +4, and greater than +4 were 0.23 (95% CI, 0.10-0.51), 0.30 (95% CI, 0.10-0.85), 0.57 (95% CI, 0.27-1.20), and 1.31 (95% CI, 0.58-2.96), respectively, relative to a change in MELD score of 0 and adjusted for age, sex, race, Charlson/Deyo Index, sepsis, number of acute organ failures, International Classification of Diseases, Ninth Revision-based injury severity score, and ICU admission MELD score.
CONCLUSIONS AND RELEVANCE: A decrease in MELD score within 72 hours of ICU admission is associated with improved mortality.
Author List
Peetz A, Salim A, Askari R, De Moya MA, Olufajo OA, Simon TG, Gibbons FK, Christopher KBAuthor
Marc Anthony De Moya MD Chief, Professor in the Surgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
BostonCritical Illness
End Stage Liver Disease
Female
Hospital Mortality
Humans
Intensive Care Units
Male
Middle Aged
Registries
Retrospective Studies
Severity of Illness Index
Trauma Centers
Wounds and Injuries