MELD score predicts mortality in critically ill cirrhotic patients Academic Article uri icon

abstract

  • Purpose Cirrhosis is a common condition that complicates the management of patients who require critical care. There is interest in identifying scoring systems that may be used to predict outcome because of the poor odds for recovery despite high-intensity care. We sought to evaluate how MELD, an organ-specific scoring system, compares with other severity of illness scoring systems in predicting short and long-term mortality for critically ill cirrhotic patients. Materials and Methods This was a retrospective cohort study involving seven intensive care units in a tertiary care, academic medical center. Adult patients with cirrhosis who were admitted to an intensive care unit between 2001 and 2008 were evaluated. Severity of illness scores (MELD, SOFA) were calculated on admission and at 24, 48 hours. The primary endpoints were 28 day and one-year all-cause mortality. Results 848 out of 19,742 ICU hospitalizations had cirrhosis. Relevant data were available for 521 patients (73%). Out of these cases, 353 (69.5%) patients were admitted to medical ICU and the other 155 (30.5%) to surgical unit. Alcohol abuse and hepatitis C were the most common reasons for cirrhosis. Patients who died within 28 days were more likely to receive mechanical ventilation, pressors, and renal replacement therapy. Among 353 medical admissions, both MELD and SOFA were found to be significantly associated with both 28-day and one-year mortality. Among the 155 surgical admissions, both scores were found to be not significant for 28-day mortality but were significant for one year. Conclusions Our results demonstrate that the prognostic ability of a variety of scoring systems strongly depends on the patient population. In the medical ICU population, each model (MELD + SOFA, MELD, SOFA) demonstrates excellent discrimination for 28-day and one-year mortality. However, these scoring systems did not predict 28 day mortality in the surgical ICU group, but were significant for one year mortality. This suggests that patients admitted to a surgical ICU will behave similarly to their medical ICU cohort if they survive the peripoerative period.

publication date

  • January 1, 2014