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Original Investigation |

Association of Model for End-Stage Liver Disease Score and Mortality in Trauma Patients With Chronic Liver Disease

Allan Peetz, MD1; Ali Salim, MD1; Reza Askari, MD1; Marc A. De Moya, MD2; Olubode A. Olufajo, MD, MPH1; Tracey G. Simon, MD3; Fiona K. Gibbons, MD4; Kenneth B. Christopher, MD5
[+] Author Affiliations
1Division of Trauma, Burns, and Surgical Critical Care, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
2Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston
3Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
4Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston
5The Nathan E. Hellman Memorial Laboratory, Renal Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
JAMA Surg. 2016;151(1):41-48. doi:10.1001/jamasurg.2015.3114.
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Importance  The Model for End-Stage Liver Disease (MELD) score is predictive of trauma outcomes.

Objective  To determine whether a decrease in MELD score is associated with improved mortality in critically ill trauma patients.

Design, Setting, and Participants  We performed a retrospective registry study of critically ill trauma patients 18 years or older with chronic liver disease treated between August 3, 1998, and January 5, 2012, at 2 level I trauma centers in Boston, Massachusetts. The consecutive sample included 525 patients (male, 373 [71.0%]; white, 399 [76.0%]; mean [SD] age, 55.0 [12.4] years).

Exposures  Change in MELD score from intensive care unit (ICU) admission to 48 to 72 hours later.

Main Outcomes and Measures  Thirty-day all-cause mortality.

Results  The mean (SD) MELD score at ICU admission was 19.3 (9.7). The 30-day mortality was 21.9%. The odds of 30-day mortality with a change in MELD score of less than −2, −2 to −1, +1 to +4, and greater than +4 were 0.23 (95% CI, 0.10-0.51), 0.30 (95% CI, 0.10-0.85), 0.57 (95% CI, 0.27-1.20), and 1.31 (95% CI, 0.58-2.96), respectively, relative to a change in MELD score of 0 and adjusted for age, sex, race, Charlson/Deyo Index, sepsis, number of acute organ failures, International Classification of Diseases, Ninth Revision–based injury severity score, and ICU admission MELD score.

Conclusions and Relevance  A decrease in MELD score within 72 hours of ICU admission is associated with improved mortality.

Figures in this Article

Figures

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Figure 1.
Flow Diagram

CPT indicates Current Procedural Terminology; ICD-9, International Classification of Diseases, Ninth Revision; ICU, intensive care unit; INR, international normalized ratio.

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Figure 2.
Survival Analysis by Change in Model for End-Stage Liver Disease (MELD)

Unadjusted event rates were calculated using Kaplan-Meier methods and compared with the use of the log-rank test. Categorization of the change in MELD scores is per the primary analyses. The global comparison log-rank, P = .003.

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