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The Prognostic Significance of MELD-XI in Patients Admitted to the Intensive Care Unit for Respiratory Failure
Fatma Arslan1, Yağmur Gizem Timurhan1, Deniz Doğan Mülazımoğlu1
1Department of Chest Diseases, Ankara University Faculty of Medicine, Ankara, Türkiye
Objective:
Composite Model for End-Stage Liver Disease (MELD), an adapted version of the model score excluding international normalised ratio (MELD-XI), was reported to predict outcomes in patients with organ failure. Aim of study was to evaluate the prognostic significance of the MELD-XI score and compare it with the Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation 2 (APACHE 2) scores in patients admitted to the intensive care unit (ICU) for respiratory failure.
Material And Methods:
Out of 822 patients with respiratory failure between September 2020 and June 2023, a total of 727 patients with etiologies of chronic obstructive pulmonary disease exacerbation, cardiogenic pulmonary edema, pulmonary thromboembolism, pneumonia, bronchiectasis, kyphoscoliosis, neuromuscular diseases, obesity hypoventilation syndrome, and diffuse parenchymal lung disease were included.
Results:
A statistically significant correlation was found between MELD-XI, SOFA, and APACHE 2 scores. The cutoff value of the MELD-XI score was 11 on receiver operating characteristic analysis, indicating a higher risk of mortality in patients with a score of 11 or above. The APACHE 2 and SOFA scores of the MELD-XI ≥11 group were found to be higher and the Glasgow Coma Scale were lower than the MELD-XI <11 group. MELD-XI ≥11 was associated with an increased risk of mortality in overall [Hazard ratio (HR): 4.1, 95% confidence interval (CI): 2-6.4, P < 0.001] and subgroups with different etiologies in Cox regression analysis. In the multivariate analysis, MELD-XI was the most important independent variable indicating an increased risk of mortality, regardless of etiology (HR: 2.4, 95% CI: 2.0-2.5, P < 0.001).
Conclusion:
MELD-XI is an important marker of ICU mortality in patients with respiratory failure due to different etiologies and is as effective as the SOFA and APACHE 2 in predicting mortality.
Insights
The MELD-XI score effectively predicts intensive care unit mortality in respiratory failure patients. It is as accurate as SOFA and APACHE 2 scores for assessing mortality risk across various causes.
Area of Science:
- Critical Care Medicine
- Pulmonology
- Prognostic Biomarkers
Background:
- The Model for End-Stage Liver Disease (MELD) score, adapted as MELD-XI (excluding INR), is used for organ failure prognostication.
- Respiratory failure is a critical condition requiring accurate prognostic tools in the intensive care unit (ICU).
Purpose of the Study:
- To evaluate the prognostic significance of the MELD-XI score in ICU patients with respiratory failure.
- To compare the predictive accuracy of MELD-XI with Sequential Organ Failure Assessment (SOFA) and APACHE 2 scores for mortality.
Main Methods:
- A cohort of 727 patients with various respiratory failure etiologies admitted to the ICU between September 2020 and June 2023 was analyzed.
- Statistical correlation, receiver operating characteristic (ROC) analysis, Cox regression, and multivariate analysis were employed to assess MELD-XI, SOFA, and APACHE 2 scores.
Main Results:
- MELD-XI showed a statistically significant correlation with SOFA and APACHE 2 scores.
- A MELD-XI score of 11 or higher was associated with increased ICU mortality (HR: 4.1) and was identified as an independent predictor (HR: 2.4).
- Patients with MELD-XI ≥11 had higher APACHE 2 and SOFA scores and lower Glasgow Coma Scale scores.
Conclusions:
- The MELD-XI score is a valuable prognostic marker for ICU mortality in patients with diverse causes of respiratory failure.
- MELD-XI demonstrates comparable effectiveness to SOFA and APACHE 2 in predicting mortality in this patient population.
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