Early evaluation of organ failure using MELD-XI in critically ill elderly COVID-19 patients,Clinical Hemorheology and Microcirculation

当前位置： X-MOL 学术 › Clin. Hemorheol. Microcirc. › 论文详情

Our official English website, www.x-mol.net, welcomes your feedback! (Note: you will need to create a separate account there.)

Early evaluation of organ failure using MELD-XI in critically ill elderly COVID-19 patients
Clinical Hemorheology and Microcirculation ( IF 2.1 ) Pub Date : 2021-08-28 , DOI: 10.3233/ch-219202
Raphael Romano Bruno ₁ , Bernhard Wernly ₂ , Johanna Hornemann ₁ , Hans Flaatten ₃ , Jesper FjØlner ₄ , Antonio Artigas ₅ , Bernardo Bollen Pinto ₆ , Joerg C Schefold ₇ , Georg Wolff ₁ , Philipp Heinrich Baldia ₁ , Stephan Binneboessel ₁ , Malte Kelm ₁ , Michael Beil ₈ , Sigal Sviri ₈ , Peter Vernon van Heerden ₉ , Wojciech Szczeklik ₁₀ , Muhammed Elhadi ₁₁ , Michael Joannidis ₁₂ , Sandra Oeyen ₁₃ , Eumorfia Kondili ₁₄ , Jakob Wollborn ₁₅ , Brian Marsh ₁₆ , Finn H Andersen _{17,

18} , Rui Moreno ₁₉ , Susannah Leaver ₂₀ , Ariane Boumendil _{21,

22} , Dylan W De Lange ₂₃ , Bertrand Guidet _{21,

22} , Christian Jung ₁ ,

Affiliation

Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany.
Department of Department of Anaesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria.
Department of Clinical Medicine, University of Bergen, Department of Anaestesia and Intensive Care, Haukeland University Hospital, Bergen, Norway.
Department of Intensive Care, Aarhus University Hospital, Aarhus, Denmark.
Department of Intensive Care Medicine, CIBER Enfermedades Respiratorias, Corporacion Sanitaria Universitaria Parc Tauli, Autonomous University of Barcelona, Sabadell, Spain.
Department of Acute Medicine, Geneva University Hospitals, Geneva, Switzerland.
Department of Intensive Care Medicine, Inselspital, Universitätsspital, University of Bern, Bern, Switzerland.
Department of Medical Intensive Care, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
General Intensive Care Unit, Dept. of Anesthesiology, Critical Care and Pain Medicine, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland.
Faculty of Medicine, University of Tripoli, Tripoli, Libya.
Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria.
Department of Intensive Care 1K12IC Ghent University Hospital, Ghent, Belgium.
Intensive Care Unit, University Hospital of Heraklion, Heraklion, Greece.
Department of Anesthesiolgy, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Mater Misericordiae University Hospital, Dublin, Ireland.
Department of Anaesthesia and Intensive Care, Ålesund Hospital, Ålesund, Norway.
Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.
Unidade de Cuidados Intensivos Neurocríticos e Trauma. Hospital de São José, Centro Hospitalar Universitário de Lisboa Central, Faculdade de Ciências Médicas de Lisboa, Nova Médical School, Lisbon, Portugal.
General Intensive care, St George's University Hospitals NHS Foundation Trust, London, UK.
Sorbonne Universités, UPMC Univ Paris, INSERM, UMR S, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Equipe: Épidémiologie Hospitaliére Qualité et Organisation des Soins, Paris, France.
Assistance Publique - Hôpitaux de Paris, Hôpital Saint-Antoine, Service De Réanimation Médicale, Paris, France.
Department of Intensive Care Medicine, University Medical Center, University Utrecht, Utrecht, The Netherlands.

Abstract

PURPOSE

Critically ill elderly patients who suffer from Sars-CoV-2 disease are at high risk for organ failure. The modified MELD-XI score has not been evaluated for outcome prediction in these most vulnerable patients.

METHODS

The Corona Virus disease (COVID19) in Very Elderly Intensive Care Patients study (COVIP, NCT04321265) prospectively recruited patients on intensive care units (ICU), who were = 70 years. Data were collected from March 2020 to February 2021. The MELD-XI score was calculated using the highest serum bilirubin and creatinine on ICU admission. Univariate and multivariable logistic regression analyses were performed to assess associations between the MELD-XI score and mortality. The primary outcome was 30-day-mortality, the secondary outcomes were ICU- and 3-month-mortality.

RESULTS

In total, data from 2,993 patients were analyzed. Most patients had a MELD-XI <12 on admission (76%). The patients with MELD-XI = 12 had a significantly higher 30-day-, ICU- and 3-month-mortality (44%vs 64%, and 42%vs. 59%, and 57%vs. 76%, p < 0.001). After adjustment for multiple confounders, MELD-XI = 12 remained significantly associated with 30-day- (aOR 1.572, CI 1.268–1.949, p < 0.001), ICU-, and 3-month-mortality.

CONCLUSION

In critically ill elderly intensive care patients with COVID-19, the MELD-XI score constitutes a valuable tool for an early outcome prediction.

中文翻译：

使用 MELD-XI 在危重老年 COVID-19 患者中早期评估器官衰竭

摘要

目的

患有 Sars-CoV-2 疾病的危重老年患者处于器官衰竭的高风险中。尚未对修改后的 MELD-XI 评分对这些最脆弱患者的结果预测进行评估。

方法

高龄重症监护患者研究 (COVIP, NCT04321265) 中的冠状病毒病 (COVID19) 前瞻性地招募了重症监护病房 (ICU) 的患者，这些患者的年龄为 70 岁。数据收集时间为 2020 年 3 月至 2021 年 2 月。 MELD-XI 评分使用 ICU 入住时的最高血清胆红素和肌酐计算。进行单变量和多变量逻辑回归分析以评估 MELD-XI 评分与死亡率之间的关联。主要结果是 30 天死亡率，次要结果是 ICU 和 3 个月死亡率。

结果

总共分析了 2,993 名患者的数据。大多数患者入院时 MELD-XI <12 (76%)。MELD-XI = 12 的患者具有显着更高的 30 天、ICU 和 3 个月死亡率（44% 对 64%、42% 对 59%、57% 对 76%，p < 0.001）。调整多个混杂因素后，MELD-XI = 12 仍然与 30 天死亡率（aOR 1.572，CI 1.268–1.949，p < 0.001）、ICU 死亡率和 3 个月死亡率显着相关。