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Original Investigation
January 2016

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

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
Abstract

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.

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