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Published on: January 17, 2025
MELD score is predictive of 90-day mortality after veno-arterial extracorporeal membrane oxygenation support
Mohamad Karnib1, Rebecca Haraf2, Nour Tashtish1
1Division of Cardiovascular Disease, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
Background:
The Model for End-Stage Liver Disease (MELD) score was originally described as a marker of survival in chronic liver disease. More recently, MELD and its derivatives, MELD excluding INR (MELD-XI) and MELD with sodium (MELD-Na), have been applied more broadly as outcome predictors in heart transplant, left ventricular assist device placement, heart failure, and cardiogenic shock, with additional promising data to support the use of these scores for prediction of survival in those undergoing veno-arterial extracorporeal membrane oxygenation (VA ECMO).
Methods:
This study assessed the prognostic impact of MELD in patients with cardiogenic shock undergoing VA ECMO via a single-center retrospective review from January 2014 to March 2020. MELD, MELD-XI, and MELD-Na scores were calculated using laboratory values collected within 48 h of VA ECMO initiation. Multivariate Cox regression analyses determined the association between MELD scores and the primary outcome of 90-day mortality. Receiver operating characteristics (ROC) were used to estimate the discriminatory power for MELD in comparison with previously validated SAVE score.
Results:
Of the 194 patients, median MELD was 20.1 (13.7-26.2), and 90-day mortality was 62.1%. There was a significant association between MELD score and mortality up to 90 days (hazard ratio (HR) = 1.945, 95% confidence interval (95% CI) = 1.244-3.041, p = 0.004) after adjustment for age, indication for VA ECMO, and sex. The prognostic significance of MELD score for 90-day mortality revealed an AUC of 0.645 (95% CI = 0.565-0.725, p < 0.001). MELD-Na score and MELD-XI score were not associated with mortality.
Conclusion:
MELD score accurately predicts long-term mortality and may be utilized as a valuable decision-making tool in patients undergoing VA ECMO.
Insights
The Model for End-Stage Liver Disease (MELD) score accurately predicts 90-day mortality in patients undergoing veno-arterial extracorporeal membrane oxygenation (VA ECMO). This score can serve as a valuable tool for decision-making in critical care settings.
Area of Science:
- Cardiology
- Critical Care Medicine
- Transplant Surgery
Background:
- The Model for End-Stage Liver Disease (MELD) score is a validated survival predictor in chronic liver disease.
- MELD and its derivatives (MELD-XI, MELD-Na) are increasingly used to predict outcomes in various cardiovascular conditions and interventions.
- Emerging evidence suggests MELD's utility in predicting survival for patients on veno-arterial extracorporeal membrane oxygenation (VA ECMO).
Purpose of the Study:
- To assess the prognostic impact of the MELD score in patients experiencing cardiogenic shock requiring VA ECMO support.
- To evaluate the predictive accuracy of MELD, MELD-XI, and MELD-Na for 90-day mortality in this patient population.
Main Methods:
- A single-center retrospective review of 194 patients undergoing VA ECMO for cardiogenic shock from January 2014 to March 2020.
- Calculation of MELD, MELD-XI, and MELD-Na scores using laboratory values within 48 hours of VA ECMO initiation.
- Multivariate Cox regression and ROC analyses to determine the association between MELD scores and 90-day mortality, comparing MELD's discriminatory power with the SAVE score.
Main Results:
- The median MELD score was 20.1, with an overall 90-day mortality rate of 62.1%.
- A significant association was found between higher MELD scores and increased 90-day mortality (HR = 1.945, p = 0.004) after adjusting for relevant covariates.
- MELD demonstrated prognostic significance with an AUC of 0.645 (p < 0.001), while MELD-Na and MELD-XI were not significantly associated with mortality.
Conclusions:
- The MELD score is an accurate predictor of long-term mortality in patients undergoing VA ECMO for cardiogenic shock.
- MELD can serve as a valuable decision-making tool for clinicians managing patients on VA ECMO.
- MELD-XI and MELD-Na did not show significant prognostic value in this cohort.
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