The Model for End-Stage Liver Disease (MELD) score is predictive of trauma outcomes.
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).
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.
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.
Peetz A, Salim A, Askari R, De Moya MA, Olufajo OA, Simon TG, Gibbons FK, Christopher KB. Association of Model for End-Stage Liver Disease Score and Mortality in Trauma Patients With Chronic Liver Disease. JAMA Surg. 2016;151(1):41-48. doi:10.1001/jamasurg.2015.3114