Prognostic Value of Model for End-Stage Liver Disease Score Measurements on a Daily Basis in Critically Ill Patients With Cirrhosis

Mayo Clin Proc. 2015 Sep;90(9):1196-206. doi: 10.1016/j.mayocp.2015.06.017. Epub 2015 Aug 3.

Abstract

Objective: To determine whether daily measurement of Model for End-Stage Liver Disease (MELD) score adds prognostic value to the initial MELD score in predicting mortality among patients with cirrhosis admitted to the intensive care unit (ICU).

Methods: We included 830 consecutive patients with cirrhosis admitted to a tertiary care ICU from January 1, 2003, through December 31, 2013, who had MELD scores on admission day 1 (MELD-D1). Daily MELD score during the first 7 days of ICU admission were retrospectively abstracted. The performances of MELD-D1 to MELD-D7 and changes in MELD score on consecutive days (Δ-MELD) in predicting 90-day mortality were determined using logistic regression.

Results: MELD-D1 was an independent predictor of mortality (adjusted odds ratio, 1.07; 95% CI, 1.05-1.10; P<.001), with an area under the receiver operating characteristic curve (AUC) of 0.72. MELD-D2 to MELD-D7 yielded comparable performance to MELD-D1 with an approximately 10% increase in risk of death per each incremental unit of MELD score (odds ratios, 1.09-1.11; P<.001; AUCs, 0.68-0.72). Δ-MELD-D2 to Δ-MELD-D7 were not independently associated with mortality (P=.69, P=.42, P=.81, P=.94, P=.83 and P=.28, respectively) and did not increase the predictive performance (AUCs) when combined with MELD-D2 to MELD-D7.

Conclusion: Repeating MELD score assessment during the first 7 days after ICU admission does not improve the ability of the initial MELD score for predicting 90-day mortality among patients with cirrhosis. Our finding does not support the practice of routine daily measurement of the MELD score.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Aged
  • Critical Illness
  • Female
  • Health Status Indicators*
  • Humans
  • Liver Cirrhosis / mortality*
  • Liver Cirrhosis / therapy
  • Male
  • Middle Aged
  • Models, Statistical*
  • Prognosis
  • Retrospective Studies
  • Severity of Illness Index
  • United States