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Title: Easy prognostic assessment of concomitant organ failure in critically ill patients undergoing mechanical ventilation
Authors: Bernhard Wernly
Fernando Frutos-Vivar
Oscar Peñuelas
Konstantinos Raymondos
Alfonso Muriel
Bin Du
Arnaud W. Thille
Fernando Ríos
Marco González
Lorenzo del-Sorbo
Maria del Carmen Marín
Bruno Valle Pinheiro
Marco Antonio Soares
Nicolas Nin
Salvatore M. Maggiore
Andrew Bersten
Malte Kelm
Pravin Amin
Nahit Cakar
Michael Lichtenauer
Gee Young Suh
Fekri Abroug
Manuel Jibaja
Dimitros Matamis
Amine Ali Zeggwagh
Yuda Sutherasan
Antonio Anzueto
Andrés Esteban
Christian Jung
South Texas Veterans Health Care System
Hospital Regional 1° de Octubre ISSSTE
CHU Fattouma-Bourguiba
Universidad Pontificia Bolivariana
Heinrich Heine Universität
Medizinische Hochschule Hannover (MHH)
Hospital Ramon y Cajal
Centre Hospitalier Universitaire de Poitiers
Samsung Medical Center, Sungkyunkwan University
Flinders University
Mohammed V University in Rabat
Paracelsus Medizinische Privatuniversitat
Papageorgiou General Hospital
Mahidol University
Istanbul Üniversitesi Tıp Fakültesi
Bombay Hospital and Medical Research Centre
Peking Union Medical College Hospital
Hospital Nacional Professor Dr. Alejandro Posadas
University of G. d'Annunzio Chieti and Pescara
Hospital Universitario de Getafe
Universidade Federal de Juiz de Fora
Hospital Universitario de Montevideo
Hospital de Especialidades Eugenio Espejo
Interdepartmental Division of Critical Care Medicine
Hospital Universitário São José
Keywords: Medicine
Issue Date: 1-Dec-2019
Citation: European Journal of Internal Medicine. Vol.70, (2019), 18-23
Abstract: © 2019 European Federation of Internal Medicine Background: Acute respiratory distress syndrome (ARDS) is a life-threatening disease. We evaluated the prognostic utility of Model for End-stage Liver Disease excluding INR (MELD-XI) score for predicting mortality in a cohort of critically ill patients on mechanical ventilation. Methods: In total, 11,091 mechanically ventilated patients were included in our post-hoc retrospective analysis, a subgroup of the VENTILA study (NCT02731898). Evaluation of associations with mortality was done by logistic and Cox regression analysis, an optimal cut-off was calculated using the Youden Index. We divided the cohort in two sub-groups based on their MELD-XI score at the optimal cut-off (12 score points). Results: Peak-, plateau- and positive end-expiratory pressure were higher in patients with MELD-XI>12. Patients with MELD-XI>12 had higher driving pressures (14 ± 6 cmH2O versus 13 ± 6; p < 0.001). MELD-XI was associated with 28-day mortality after correction for relevant cofounders including SAPS II and ventilation pressures (HR 1.04 95%CI 1.03–1.05; p < 0.001. Patients with MELD-XI>12 evidenced both increased hospital (46% versus 27%; p < 0.001) and 28-day mortality (39% versus 22%). Conclusions: MELD-XI is independently associated with mortality and constitutes a useful and easily applicable tool for risk stratification in critically ill patients receiving mechanical ventilation. Trial registration: NCT02731898, registered 4 April 2016.
ISSN: 18790828
Appears in Collections:Scopus 2019

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