Bernhard WernlyFernando Frutos-VivarOscar PeñuelasKonstantinos RaymondosAlfonso MurielBin DuArnaud W. ThilleFernando RíosMarco GonzálezLorenzo del-SorboMaria del Carmen MarínBruno Valle PinheiroMarco Antonio SoaresNicolas NinSalvatore M. MaggioreAndrew BerstenMalte KelmPravin AminNahit CakarMichael LichtenauerGee Young SuhFekri AbrougManuel JibajaDimitros MatamisAmine Ali ZeggwaghYuda SutherasanAntonio AnzuetoAndrés EstebanChristian JungSouth Texas Veterans Health Care SystemHospital Regional 1° de Octubre ISSSTECHU Fattouma-BourguibaUniversidad Pontificia BolivarianaHeinrich Heine UniversitätMedizinische Hochschule Hannover (MHH)Hospital Ramon y CajalCentre Hospitalier Universitaire de PoitiersSamsung Medical Center, Sungkyunkwan UniversityFlinders UniversityMohammed V University in RabatParacelsus Medizinische PrivatuniversitatPapageorgiou General HospitalMahidol UniversityIstanbul Üniversitesi Tıp FakültesiBombay Hospital and Medical Research CentrePeking Union Medical College HospitalHospital Nacional Professor Dr. Alejandro PosadasUniversity of G. d'Annunzio Chieti and PescaraHospital Universitario de GetafeUniversidade Federal de Juiz de ForaHospital Universitario de MontevideoHospital de Especialidades Eugenio EspejoInterdepartmental Division of Critical Care MedicineHospital Universitário São José2020-01-272020-01-272019-12-01European Journal of Internal Medicine. Vol.70, (2019), 18-2318790828095362052-s2.0-85073027955https://repository.li.mahidol.ac.th/handle/20.500.14594/51295© 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.Mahidol UniversityMedicineArticleSCOPUS10.1016/j.ejim.2019.09.002