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Modified model for end-stage liver disease score predicts 30-day mortality in high-risk patients with acute pulmonary embolism admitted to intensive care units
Scandinavian Cardiovascular Journal ( IF 2.2 ) Pub Date : 2021-01-25 , DOI: 10.1080/14017431.2021.1876912
Kadir İdin 1 , Seçkin Dereli 2 , Ahmet Kaya 2 , Mustafa Yenerçağ 3 , Ahmet Seyda Yılmaz 4 , Kaptanıderya Tayfur 5 , Oktay Gülcü 6
Affiliation  

Abstract

Objectives

The Model for End-stage Liver Disease excluding the international normalised ratio that is derived from prothrombin time which is calculated as a ratio of the patient’s prothrombin time to a control prothrombin time standardized (MELD-XI) and modified MELD, which uses albumin in place of the international normalised ratio (MELD-Albumin) scores reflect liver and renal function and are predictors of mortality. However, their prognostic value in acute pulmonary embolism (APE) has not been studied.

Design

We assessed the predictive value of the MELD scores in patients diagnosed with high-risk APE admitted to the intensive care unit. The primary outcome was 30-day mortality.

Results

Of the 273 patients included in the study, 231 were survivors and 42 were non-survivors. The mortality rate was 15.3%. The mean MELD-XI and MELD-Albumin scores were significantly higher in the non-survivors than in the survivors (MELD XI, 11.8 ± 1.8 and 10.6 ± 1.43, respectively; p = .002; MELD-Albumin, 10.5 ± 1.6 and 8.7 ± 1.1, respectively; p = .001). The multiple logistic regression analysis identified the MELD-XI (hazard ratio: 3.029, confidence interval: 1.06–1.21, p = .007) and MELD-Albumin (hazard ratio: 1.13, confidence interval: 1.06–1.21, p = .002) scores as independent predictors of mortality. Receiver operating characteristic analysis revealed that the predictive power of the MELD-Albumin score (0.871 ± 0.014; p < .001) was higher than those of the MELD-XI (0.726 ± 0.022, p < .001), APACHE III (0.682 ± 0.024, p < .001), and PESI (0.624 ± 0.023, p < .001) scores.

Conclusions

The MELD-Albumin score is an easily calculable, reliable, and practical risk assessment tool and independent predictor of 30-day mortality in patients with high-risk APE.



中文翻译:

终末期肝病评分的修正模型可预测入住重症监护病房的急性肺栓塞高危患者的 30 天死亡率

摘要

目标

终末期肝病模型不包括源自凝血酶原时间的国际标准化比率,该比率计算为患者凝血酶原时间与对照凝血酶原时间标准化 (MELD-XI) 和改良 MELD 的比率,后者使用白蛋白到位国际标准化比值 (MELD-白蛋白) 评分反映肝肾功能,是死亡率的预测因子。然而,尚未研究它们在急性肺栓塞 (APE) 中的预后价值。

设计

我们评估了 MELD 评分对入住重症监护病房的高危 APE 患者的预测价值。主要结局是 30 天死亡率。

结果

在纳入研究的 273 名患者中,231 名幸存者和 42 名非幸存者。死亡率为15.3%。非幸存者的平均 MELD-XI 和 MELD-白蛋白评分显着高于幸存者(MELD XI,分别为 11.8 ± 1.8 和 10.6 ± 1.43;p  = .002;MELD-白蛋白,10.5 ± 1.6 和 8.7 ± 1.1,分别为;p  = .001)。多元逻辑回归分析确定了 MELD-XI(风险比:3.029,置信区间:1.06–1.21,p  = .007)和 MELD-白蛋白(风险比:1.13,置信区间:1.06–1.21,p  = .002)分数作为死亡率的独立预测因子。接受者操作特征分析显示,MELD-白蛋白评分的预测能力(0.871 ± 0.014;p  < .001) 高于 MELD-XI (0.726 ± 0.022, p  < .001)、APACHE III (0.682 ± 0.024, p  < .001) 和 PESI (0.624 ± 0.023, p  < .001)分数。

结论

MELD-白蛋白评分是一种易于计算、可靠且实用的风险评估工具,是高危 APE 患者 30 天死亡率的独立预测指标。

更新日期:2021-01-25
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