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The association between the MELD-XI score and 30-day mortality in ICU patients with sepsis: a retrospective cohort
Jiehe Mai1, Yanfang Wang1, Xiaowan Li2
1Zhongshan City People's Hospital, Zhongshan, 528400, Guangdong, People's Republic of China.
Abstract:
Sepsis is a leading cause of mortality among ICU patients. Although APACHE IV and SOFA scores are widely employed for prognostic assessment, their complexity and dependence on extensive data may limit their effectiveness in early risk identification. The MELD-XI score, derived from serum total bilirubin and creatinine, offers a simple calculation method and has demonstrated strong prognostic value in liver disease, organ transplantation, and cardiovascular conditions. However, its prognostic utility in ICU patients with sepsis has not been systematically evaluated. In this study, we retrospectively analyzed 16,691 adult patients diagnosed with sepsis within 48 h of ICU admission using data from the eICU Collaborative Research Database. Through the application of a generalized additive model and a two-stage linear regression model, we identified for the first time a significant nonlinear association and a threshold effect between MELD-XI scores and 30-day all-cause mortality. The turning point was determined at a MELD-XI score of 25.74, with mortality risk increasing by 1.1% per unit below the threshold and by 5.5% per unit above it. Stratified subgroup analyses confirmed the consistency of this association across most clinical categories. These findings suggest that the MELD-XI score may serve as a simple, accessible, and complementary tool for early risk stratification and clinical decision-making in ICU patients with sepsis.
Insights
The MELD-XI score, using bilirubin and creatinine, effectively predicts 30-day mortality in sepsis patients. A threshold of 25.74 indicates increased risk, offering a simpler tool for intensive care unit (ICU) risk stratification.
Area of Science:
- Critical Care Medicine
- Biomarkers and Prognostic Indicators
- Epidemiology
Background:
- Sepsis is a major cause of intensive care unit (ICU) mortality.
- Existing prognostic scores like APACHE IV and SOFA are complex and data-intensive, limiting early risk assessment.
- The MELD-XI score, a simpler measure, shows promise but its utility in sepsis needs evaluation.
Purpose of the Study:
- To evaluate the prognostic utility of the MELD-XI score for 30-day mortality in ICU patients with sepsis.
- To identify potential nonlinear associations and threshold effects of MELD-XI scores on mortality.
- To assess MELD-XI as a complementary tool for early risk stratification in sepsis.
Main Methods:
- Retrospective analysis of 16,691 adult sepsis patients admitted to the ICU within 48 hours.
- Utilized data from the eICU Collaborative Research Database.
- Employed generalized additive and two-stage linear regression models to analyze MELD-XI score and mortality.
Main Results:
- Identified a significant nonlinear association between MELD-XI scores and 30-day all-cause mortality.
- Determined a mortality risk threshold at a MELD-XI score of 25.74.
- Mortality risk increased by 1.1% per unit below and 5.5% per unit above this threshold, consistent across subgroups.
Conclusions:
- The MELD-XI score demonstrates significant prognostic value for 30-day mortality in ICU sepsis patients.
- A MELD-XI score of 25.74 serves as a critical threshold for increased mortality risk.
- MELD-XI offers a simple, accessible tool for early risk stratification and clinical decision-making in sepsis management.
