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Published on: June 4, 2012
The Model for End-stage Liver Disease (MELD) as a predictor of short-term mortality in Staphylococcus aureus
Jan A Roth1,2, Andreas F Widmer1,2, Sarah Tschudin-Sutter1,2
1Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland.
Background:
Automated laboratory-based prediction models may support clinical decisions in Staphylococcus aureus bloodstream infections (BSIs), which carry a particularly high mortality. Small studies indicated that the laboratory-based Model for End-stage Liver Disease (MELD) score is a risk factor for mortality in critically ill patients with infections. For S. aureus BSIs, we therefore aimed to assess a potential association of the MELD score with mortality.
Methods:
In this single-centre observational study, all consecutive patients with a first episode of methicillin-susceptible S. aureus BSI occurring between 2001 and 2013 were eligible. Relevant patient data were retrieved from our prospective in-house BSI database. We assessed the association of the MELD score at day of BSI onset (range ± two days) with 30-day all-cause mortality using uni- and multivariable logistic regression analysis.
Results:
561 patients were included in the final analysis. The MELD score at BSI onset was associated with 30-day mortality in S. aureus BSIs (odds ratio per 1-point increase, 1.06; 95% confidence interval, 1.03‒1.09; P < 0.001). After adjustment for relevant patient and infection characteristics, an increased MELD score remained a predictor of 30-day mortality (adjusted odds ratio per 1-point increase, 1.05; 95% confidence interval, 1.01‒1.08; P = 0.005).
Conclusions:
In our study population, the MELD score at BSI onset was an independent predictor of mortality in S. aureus BSIs. We therefore suggest to prospectively validate the MELD score as part of clinical decision support systems in inpatients with suspected or confirmed BSI.
Insights
The Model for End-stage Liver Disease (MELD) score predicts mortality in Staphylococcus aureus bloodstream infections (BSIs). Higher MELD scores are independently associated with increased 30-day mortality in these critical infections.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Clinical Prediction Models
Background:
- Staphylococcus aureus bloodstream infections (BSIs) are associated with high mortality.
- The Model for End-stage Liver Disease (MELD) score has shown potential as a mortality predictor in critically ill patients with infections.
Purpose of the Study:
- To assess the association between the MELD score and mortality in patients with S. aureus BSIs.
Main Methods:
- A single-center observational study included 561 consecutive patients with methicillin-susceptible S. aureus BSI from 2001-2013.
- The MELD score at BSI onset was analyzed for association with 30-day all-cause mortality using logistic regression.
Main Results:
- The MELD score at BSI onset was significantly associated with 30-day mortality (OR 1.06 per point, P < 0.001).
- After multivariable adjustment, an increased MELD score remained an independent predictor of 30-day mortality (aOR 1.05 per point, P = 0.005).
Conclusions:
- The MELD score at BSI onset is an independent predictor of mortality in S. aureus BSIs.
- Prospective validation of the MELD score in clinical decision support systems for BSIs is recommended.