Background It is unclear whether the model for end-stage liver disease excluding international normalized ratio(MELD-XI),in addition to the Thrombolysis In Myocardial Infarction(TIMI)risk score,had prognostic value in...Background It is unclear whether the model for end-stage liver disease excluding international normalized ratio(MELD-XI),in addition to the Thrombolysis In Myocardial Infarction(TIMI)risk score,had prognostic value in patients with ST-segment elevation myocardial infarction(STEMI)undergoing percutaneous coronary intervention(PCI).Methods 189 STEMI patients undergoing PCI were consecutively included and classified into two groups based on the cut-off of MELD-XI,which was determined by receiver operating characteristic(ROC)curve analysis:low MELD-XI group(<10,n=135)and high MELD-XI group(≥10,n=54).The association of MELD-XI with adverse events was analyzed.Results During hospitalization,5(2.6%)patients died,57(30.2%)suffered acute heart failure,4(2.1%)needed renal replacement treatment,2(1.1%)suffered stroke and 1(0.5%)received target vessel revascularization.ROC curve analysis showed that MELD-XI≥10 was an optimal cut-off for predicting in-hospital MACEs[area under the curve(AUC):0.684,95%CI:0.599-769,P<0.001].The in-hospital major adverse clinical events(MACEs)was significantly higher in patients with high MELD-XI(51.9%vs.23.0%,P<0.001).Multivariate analysis showed that MELD-XI≥10 was an independent risk factor for in-hospital MACEs after adjusting for TIMI risk score(OR:3.59,95%CI:1.79-7.19,P<0.001).Conclusions MELD-XI,in addition to the TIMI risk score,might provide prognostic value for STEMI patients undergoing PCI.展开更多
目的本研究旨在探讨终末期肝病模型-排除国际标准化比率(model for end-stage liver disease-excluding international normalized ratio,MELD-XI)评分是否能够预测静脉-动脉体外膜氧合支持患者的预后。方法本研究为回顾性队列研究,回...目的本研究旨在探讨终末期肝病模型-排除国际标准化比率(model for end-stage liver disease-excluding international normalized ratio,MELD-XI)评分是否能够预测静脉-动脉体外膜氧合支持患者的预后。方法本研究为回顾性队列研究,回顾性纳入2015年1月至2023年12月阜外华中心血管病医院使用体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)患者的临床数据资料。纳入标准:⑴使用VA-ECMO的临床患者,不包括VAV-ECMO和VV-ECMO;⑵上机最初24 h内有可用的血肌酐和总胆红素化验值;⑶患者基本信息完整;⑷年龄大于18周岁。排除标准:⑴家属因经济原因放弃治疗患者;⑵上机时间不足24 h;⑶临床信息不完整患者或未详细记录VA-ECMO一般资料的患者。采用X-tile软件,分为MELD-XI评分≤13.9组和MELD-XI评分>13.9组,采用单因素分析后将P<0.05的变量纳入二元Logistic回归模型。结果对940例患者单因素分析结果发现,MELD-XI评分≤13.9组和MELD-XI评分>13.9组相比,在成功撤机(χ^(2)=31.812,P<0.001)、机器运转时死亡(χ^(2)=52.453,P<0.001)、撤机后死亡(χ^(2)=4.210,P=0.040)、脑血栓并发症(χ^(2)=4.319,P=0.038)、下肢血栓并发症(χ^(2)=8.789,P=0.003)、CRRT使用(χ^(2)=15.648,P<0.001)、上机时长(Z=-17.786,P<0.001)、住院时长(Z=-17.503,P<0.001)、ICU停留时间(Z=-18.790,P<0.001)差异具有统计学意义。多因素二元Logistic回归显示成功撤机(OR=2.078,95%CI:1.158~3.731,P=0.014)、机器运转时死亡(OR=0.271,95%CI:0.144~0.512,P<0.001)、CRRT使用(OR=3.227,95%CI:1.659~6.474,P=0.001)、住院时长(OR=1.138,95%CI:1.107~1.171,P<0.001)、上机时长(OR=1.035,95%CI:1.027~1.043,P<0.001)、ICU停留时间(OR=1.365,95%CI:1.278~1.458,P<0.001)是VA-ECMO支持患者的独立影响因素。Kaplan-Meier曲线分析显示MELD-XI评分≤13.9组住院病死率(HR=2.167,95%CI:1.508~3.114,P<0.001)和撤机成功率(HR=5.353,95%CI:4.023~7.121,P<0.001)均显著低于MELD-XI评分>13.9组。结论MELD-XI评分可以预测VA-ECMO支持患者的预后,帮助临床大夫进行复杂的临床决策。展开更多
Background Renal and liver dysfunction,which are common complications in infectious diseases,are associated with poor clinical outcomes.This study aimed to evaluate the prognostic value of the Model for End-Stage Live...Background Renal and liver dysfunction,which are common complications in infectious diseases,are associated with poor clinical outcomes.This study aimed to evaluate the prognostic value of the Model for End-Stage Liver Disease Excluding International Normalized Ratio(MELD-XI)score for predicting short-term mortality in patients with infective endocarditis(IE)complicated by sepsis.Methods A total of 496 consecutive IE patients complicated with sepsis at Guangdong Provincial People's Hospital were enrolled and divided into three groups according to the tertiles of MELD-XI score:<7.9(n=164),7.9-14.6(n=168),and>14.6(n=164).Major adverse clinical events(MACE)were composite endpoints that included acute heart failure,renal dialysis,stroke,and death during hospitalization.Multivariate analysis was used to explore the prognostic value of MELD-XI score.Results In-hospital and 6-month mortality were 14.3%and 21.5%,respectively.In-hospital mortality and the incidence of MACE rose significantly with higher MELD-XI scores(mortality:8.5%vs.12.5%vs.14.3%,P=0.002;Incidence of MACE:24.4%vs.31%vs.51.2%,P<0.001).Receiver operating characteristic(ROC)curve analysis showed that the optimal cutoff value of MELD-XI score was 15.7[area under the curve(AUC):0.648,95%CI:0.578-0.718,P<0.001].Multivariate regression analysis revealed that MELD-XI score>15.7 was a significantly independent risk factor for both in-hospital[adjusted odds ratio(OR):2.27,95%CI:1.28-4.05,P=0.005]and 6-month mortality[adjusted hazard ratio(HR):1.69,95%CI:1.13-2.53,P=0.011].Conclusions MELD-XI score>15.7 was independently associated with short-term mortality in IE patients complicated with sepsis,suggesting its potential value as a prognostic biomarker for risk stratification in this population.展开更多
Liver dysfunction was associated with poor outcomes in patients with ST-segment elevation myocardial infarction(STEMI).However,the optimal methods for assessing the liver function was unclear.This study was to compare...Liver dysfunction was associated with poor outcomes in patients with ST-segment elevation myocardial infarction(STEMI).However,the optimal methods for assessing the liver function was unclear.This study was to compare the predictive value of the different liver function assessment tools for in-hospital and oneyear adverse events in STEMI patients undergoing percutaneous coronary intervention(PCI).Methods A total of 1157 patients with STEMI undergoing PCI were enrolled from January 2012 to December 2015.The model for end-stage liver disease excluding international normalized ratio(MELD-XI)and albumin-bilirubin(ALBI)score were calculated at admission.The discrimination and calibration of these two scores for in-hospital and oneyear adverse events were compared.Results The in-hospital mortality was 4.0%.Both MELD-XI[area under the curve(AUC)=0.768,95%confidence interval(CI):0.691-0.845,P<0.001]and ALBI score(AUC=0.682,95%CI:0.602-0.761,P<0.001)had excellent discrimination for in-hospital death.The calibration for in-hospital death was good in MELD-XI(Hosmer-Lemeshow chi-square=7.2,P=0.520),but not good in ALBI score(Hosmer-Lemeshow chi-square=13.8,P=0.087).In addition,the predictive power of MELD-XI for in-hospital death was better than ALBI score(AUC:0.768 vs.0.682,P=0.037).1108(95.8%)patients completed one-year followup.Kaplan-Meier analysis showed that patients with a high MELD-XI score had high-risk of one-year mortality(Log-rank test:54.8,P<0.001).Conclusions As the method for assessing the liver function,MELD-XI was better than ALBI score in predicting the in-hospital and one-year adverse events in STEMI patients,which could be considered as a risk assessment tool.展开更多
文摘Background It is unclear whether the model for end-stage liver disease excluding international normalized ratio(MELD-XI),in addition to the Thrombolysis In Myocardial Infarction(TIMI)risk score,had prognostic value in patients with ST-segment elevation myocardial infarction(STEMI)undergoing percutaneous coronary intervention(PCI).Methods 189 STEMI patients undergoing PCI were consecutively included and classified into two groups based on the cut-off of MELD-XI,which was determined by receiver operating characteristic(ROC)curve analysis:low MELD-XI group(<10,n=135)and high MELD-XI group(≥10,n=54).The association of MELD-XI with adverse events was analyzed.Results During hospitalization,5(2.6%)patients died,57(30.2%)suffered acute heart failure,4(2.1%)needed renal replacement treatment,2(1.1%)suffered stroke and 1(0.5%)received target vessel revascularization.ROC curve analysis showed that MELD-XI≥10 was an optimal cut-off for predicting in-hospital MACEs[area under the curve(AUC):0.684,95%CI:0.599-769,P<0.001].The in-hospital major adverse clinical events(MACEs)was significantly higher in patients with high MELD-XI(51.9%vs.23.0%,P<0.001).Multivariate analysis showed that MELD-XI≥10 was an independent risk factor for in-hospital MACEs after adjusting for TIMI risk score(OR:3.59,95%CI:1.79-7.19,P<0.001).Conclusions MELD-XI,in addition to the TIMI risk score,might provide prognostic value for STEMI patients undergoing PCI.
文摘Background Renal and liver dysfunction,which are common complications in infectious diseases,are associated with poor clinical outcomes.This study aimed to evaluate the prognostic value of the Model for End-Stage Liver Disease Excluding International Normalized Ratio(MELD-XI)score for predicting short-term mortality in patients with infective endocarditis(IE)complicated by sepsis.Methods A total of 496 consecutive IE patients complicated with sepsis at Guangdong Provincial People's Hospital were enrolled and divided into three groups according to the tertiles of MELD-XI score:<7.9(n=164),7.9-14.6(n=168),and>14.6(n=164).Major adverse clinical events(MACE)were composite endpoints that included acute heart failure,renal dialysis,stroke,and death during hospitalization.Multivariate analysis was used to explore the prognostic value of MELD-XI score.Results In-hospital and 6-month mortality were 14.3%and 21.5%,respectively.In-hospital mortality and the incidence of MACE rose significantly with higher MELD-XI scores(mortality:8.5%vs.12.5%vs.14.3%,P=0.002;Incidence of MACE:24.4%vs.31%vs.51.2%,P<0.001).Receiver operating characteristic(ROC)curve analysis showed that the optimal cutoff value of MELD-XI score was 15.7[area under the curve(AUC):0.648,95%CI:0.578-0.718,P<0.001].Multivariate regression analysis revealed that MELD-XI score>15.7 was a significantly independent risk factor for both in-hospital[adjusted odds ratio(OR):2.27,95%CI:1.28-4.05,P=0.005]and 6-month mortality[adjusted hazard ratio(HR):1.69,95%CI:1.13-2.53,P=0.011].Conclusions MELD-XI score>15.7 was independently associated with short-term mortality in IE patients complicated with sepsis,suggesting its potential value as a prognostic biomarker for risk stratification in this population.
基金supported by grants from Science and Technology Projects of Guangzhou(No.201903010097)。
文摘Liver dysfunction was associated with poor outcomes in patients with ST-segment elevation myocardial infarction(STEMI).However,the optimal methods for assessing the liver function was unclear.This study was to compare the predictive value of the different liver function assessment tools for in-hospital and oneyear adverse events in STEMI patients undergoing percutaneous coronary intervention(PCI).Methods A total of 1157 patients with STEMI undergoing PCI were enrolled from January 2012 to December 2015.The model for end-stage liver disease excluding international normalized ratio(MELD-XI)and albumin-bilirubin(ALBI)score were calculated at admission.The discrimination and calibration of these two scores for in-hospital and oneyear adverse events were compared.Results The in-hospital mortality was 4.0%.Both MELD-XI[area under the curve(AUC)=0.768,95%confidence interval(CI):0.691-0.845,P<0.001]and ALBI score(AUC=0.682,95%CI:0.602-0.761,P<0.001)had excellent discrimination for in-hospital death.The calibration for in-hospital death was good in MELD-XI(Hosmer-Lemeshow chi-square=7.2,P=0.520),but not good in ALBI score(Hosmer-Lemeshow chi-square=13.8,P=0.087).In addition,the predictive power of MELD-XI for in-hospital death was better than ALBI score(AUC:0.768 vs.0.682,P=0.037).1108(95.8%)patients completed one-year followup.Kaplan-Meier analysis showed that patients with a high MELD-XI score had high-risk of one-year mortality(Log-rank test:54.8,P<0.001).Conclusions As the method for assessing the liver function,MELD-XI was better than ALBI score in predicting the in-hospital and one-year adverse events in STEMI patients,which could be considered as a risk assessment tool.
