An analytical study of the MELD-XI score to predict prognosis in patients on veno-arterial extracorporeal membrane oxygenation support
10.3760/cma.j.cn114656-20240710-00492
- VernacularTitle:MELD-XI评分预测静脉-动脉体外膜氧合支持患者的预后分析研究
- Author:
Jianzhao LI
1
;
Xiaoliang QIAN
;
Fanwei MENG
;
Peijun REN
;
Zhaoyun CHENG
Author Information
1. 河南省人民医院 郑州大学人民医院 阜外华中心血管病医院体外循环科，郑州 450016
- Keywords:
MELD-XI score;
Veno-arterial extracorporeal membrane oxygenation;
Prognostic analysis
- From:
Chinese Journal of Emergency Medicine
2025;34(7):964-969
- CountryChina
- Language:Chinese
-
Abstract:
Objective:The aim of this study was to investigate whether the Model for end-stage liver disease-excluding international normalised ratio ( MELD-XI) score whether it can predict the prognosis of patients on veno-arterial extracorporeal membrane oxygenation support.Methods:This study was a retrospective cohort study, which retrospectively included clinical data data of patients using ECMO from January 2015 to December 2023 in Fuwai Huazhong Cardiovascular Disease Hospital. Inclusion criteria: 1. clinical patients using VA-ECMO, excluding VAV-ECMO and VV-ECMO; 2. available laboratory values of blood creatinine and total bilirubin within the first 24 hours of on-boarding; 3. complete basic information of the patients; and 4. age greater than 18 years. Exclusion criteria: 1. patients whose family members abandoned the treatment due to economic reasons; 2. on-boarding time less than 24 hours; 3. patients with incomplete clinical information or patients who did not have a detailed record of general information on VA-ECMO. Using X-tile software, they were divided into MELD-XI score ≤13.9 and MELD-XI score >13.9 groups, and variables with P < 0.05 were included in the binary logistic regression model after using univariate analysis. Results:: Univariate analysis of 940 patients revealed that the MELD-XI score ≤13.9 group compared with the MELD-XI score >13.9 group had a significant difference in the success of machine withdrawal ( χ2=31.812, P<0.001), death while the machine was in operation ( χ2=52.453, P<0.001), death after machine withdrawal ( χ2=4.210, P=0.040), cerebral thrombotic complications ( χ2=4.319, P=0.038), lower extremity thrombotic complications ( χ2=8.789, P=0.003), and CRRT use ( χ2=15.648, P<0.001), length of boarding (Z=-17.786, P<0.001), length of hospital stay (Z=-17.503, P<0.001), and length of ICU stay ( Z=-18.790, P<0.001) were significantly different. Multifactorial binary logistic regression showed that successful machine withdrawal ( OR=2.078, 95% CI:1.158-3.731, P=0.014), death while the machine was running ( OR=0.271, 95% CI:0.144-0.512, P<0.001), CRRT use ( OR=3.227, 95% CI:1.659-6.474, P=0.001), length of hospital stay ( OR=1.138, 95% CI:1.107-1.171, P<0.001), length of boarding ( OR=1.035, 95% CI:1.027-1.043, P<0.001), ICU stay ( OR=1.365, 95% CI:1.278-1.458, P < 0.001) are independent influencing factor for VA-ECMO support patients. Kaplan-Meier curve analysis showed that both in-hospital mortality ( HR=2.167, 95% CI:1.508-3.114, P<0.001) and withdrawal success ( HR=5.353, 95% CI:4.023-7.121, P<0.001) were significantly lower in the MELD-XI score ≤13.9 group than in the MELD-XI score >13.9 group. Conclusions:The MELD-XI score can predict the prognosis of VA-ECMO-supported patients and help clinician doctors to make complex clinical decisions.
