TY - JOUR
T1 - MELD score is predictive of 90-day mortality after veno-arterial extracorporeal membrane oxygenation support
AU - Karnib, Mohamad
AU - Haraf, Rebecca
AU - Tashtish, Nour
AU - Zanath, Erica
AU - Elshazly, Tarek
AU - Garcia, Raul Angel
AU - Billings, Scott
AU - Fetros, Michael
AU - Bradigan, Allison
AU - Zacharias, Michael
AU - Abu-Omar, Yasir
AU - Elgudin, Yakov
AU - Pelletier, Marc
AU - Al-Kindi, Sadeer
AU - Lytle, Francis
AU - ElAmm, Chantal
N1 - Publisher Copyright:
© The Author(s) 2021.
PY - 2022/4
Y1 - 2022/4
N2 - 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.
AB - 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.
KW - acute heart failure
KW - cardiogenic shock
KW - Model for End-Stage Liver Disease
KW - mortality
KW - Veno-arterial extracorporeal membrane oxygenation
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U2 - 10.1177/03913988211054865
DO - 10.1177/03913988211054865
M3 - Article
C2 - 34702105
AN - SCOPUS:85118186567
SN - 0391-3988
VL - 45
SP - 404
EP - 411
JO - International Journal of Artificial Organs
JF - International Journal of Artificial Organs
IS - 4
ER -