MELD score tied to survival in trauma patients with liver disease

Last Updated: 2015-10-05

By David Douglas

NEW YORK (Reuters Health) - Improvement in Model for End-Stage Liver Disease (MELD) score in critically ill trauma patients with chronic liver disease is associated with lower mortality, according to Boston-based researchers.

As Dr. Kenneth B. Christopher told Reuters Health by email, "Our observational study shows that in trauma patients with cirrhosis, those with decreases in MELD score within the first 3 days of ICU admission have higher survival."

He added, "As MELD score has three components (serum bilirubin, serum creatinine and INR), improved survival with decreased MELD score may reflect improvements in kidney function which is known to correlate with outcomes."

For their study, online September 30 in JAMA Surgery, Dr. Christopher of Brigham and Women's Hospital and colleagues examined data on 525 patients treated between 1998 and 2002.

The mean MELD score at ICU admission was 19.3 and the 30-day mortality was 21.9%. After adjustment, the odds of 30-day mortality for each 1-point rise in this score were significantly increased (odds ratio, 1.03). Conversely, for a drop in MELD score of more than 2, for example, the odds of 30-day mortality fell by 77%.

"The change in MELD score," the researchers say, "improves model performance and discrimination when added to a model that includes MELD score at ICU admission."

However, they add, "because our study is observational and not interventional, a causal relationship between change in MELD score and outcomes after trauma cannot be inferred from these data alone."

Commenting on the findings by email, Dr. Timothy A. Pritts, author of an accompanying editorial, told Reuters Health, "Key findings from the study include that in trauma patients with cirrhosis of the liver, decreased in MELD score during the first few days of admission are associated with improved survival in these critically ill patients."

"This suggests that trauma surgeons and intensivists should evaluate the dynamics of the MELD score, rather than viewing it as an isolated data point," Dr. Pritts, of the University of Cincinnati Medical Center, Ohio, concluded.

SOURCE: http://bit.ly/1MU2uYw and http://bit.ly/1jJZDYz

JAMA Surg 2015.