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Malnutrition and low muscle strength are independent predictors of clinical outcomes and healthcare costs after liver transplant. Clin Nutr ESPEN 2022; 48:210-219. [DOI: 10.1016/j.clnesp.2022.02.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 02/14/2022] [Indexed: 11/21/2022]
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Cardiovascular Evaluation of Liver Transplant Patients by Using Coronary Calcium Scoring in ECG-Synchronized Computed Tomographic Scans. J Clin Med 2021; 10:jcm10215148. [PMID: 34768667 PMCID: PMC8584855 DOI: 10.3390/jcm10215148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 10/22/2021] [Accepted: 11/01/2021] [Indexed: 12/04/2022] Open
Abstract
Background: The goal of cardiac evaluation of patients awaiting orthotopic liver transplantation (OLT) is to identify the patients at risk for cardiovascular events (CVEs) in the peri- and postoperative periods by opportunistic evaluation of coronary artery calcium (CAC) in non-gated abdominal computed tomographs (CT). Methods: We hypothesized that in patients with OLT, a combination of Lee’s revised cardiac index (RCRI) and CAC scoring would improve diagnostic accuracy and prognostic impact compared to non-invasive cardiac testing. Therefore, we retrospectively evaluated 169 patients and compared prediction of CVEs by both methods. Results: Standard workup identified 22 patients with a high risk for CVEs during the transplant period, leading to coronary interventions. Eighteen patients had a CVE after transplant and a CAC score > 0. The combination of CAC and RCRI ≥ 2 had better negative (NPV) and positive predictive values (PPV) for CVEs (NPV 95.7%, PPV 81.6%) than standard non-invasive stress tests (NPV 92.0%, PPV 54.5%). Conclusion: The cutoff value of CAC > 0 by non-gated CTs combined with RCRI ≥ 2 is highly sensitive for identifying patients at risk for CVEs in the OLT population.
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Sharma S, Sonny A, Dalia AA, Karamchandani K. Acute heart failure after liver transplantation: A narrative review. Clin Transplant 2020; 34:e14079. [PMID: 32941661 DOI: 10.1111/ctr.14079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/06/2020] [Accepted: 08/27/2020] [Indexed: 11/27/2022]
Abstract
Acute heart failure (AHF) is an under recognized yet potentially lethal complication after liver transplantation (LT) surgery. The increase in incidence of liver transplantation amongst high-risk patients and the leniency in the criteria for transplantation, predisposes these patients to postoperative AHF and the antecedent morbidity and mortality. The inability of conventional preoperative cardiovascular testing to accurately identify patients at risk for post-LT AHF poses a considerable challenge to clinicians caring for these patients. Even if high-risk patients are identified, there is considerable ambiguity in the candidacy for transplantation as well as optimization strategies that could potentially prevent the development of AHF in the postoperative period. The intraoperative and postoperative management of patients who develop AHF is also challenging and requires a well-coordinated multidisciplinary approach. The use of mechanical circulatory support in patients with refractory heart failure has the potential to improve outcomes but its use in this complex patient population can be associated with significant complications and requires a stringent risk-benefit analysis on a case-by-case basis.
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Affiliation(s)
- Sonal Sharma
- Department of Anesthesiology and Perioperative Medicine, Penn State Health Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA, USA
| | - Abraham Sonny
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Adam A Dalia
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Kunal Karamchandani
- Department of Anesthesiology and Perioperative Medicine, Penn State Health Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA, USA
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Keskin S, Çiftci O, Moray G, Müderrisoğlu H, Haberal M. MELD-XI Score and Coronary Artery Disease Prevalence and Extent Among In-Hospital Patients With End-Stage Liver Failure Awaiting Transplant. EXP CLIN TRANSPLANT 2020; 18:88-92. [PMID: 32008505 DOI: 10.6002/ect.tond-tdtd2019.p32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Liver transplant is a life-saving procedure for a variety of end-stage liver diseases. Cardiovascular disorders are among the leading cause of death among patients with end-stage liver disease and those undergoing liver transplant procedures. MELD-XI score is a newly developed score for mortality prediction in patients with end-stage liver failure. In this study, we investigated the relationships among MELD-XI score, total in-hospital mortality, and coronary artery disease severity and extent among patients with end-stage liver failure who were awaiting transplant. MATERIALS AND METHODS We retrospectively reviewed medical records of 121 patients with end-stage liver failure on transplant wait list. Study patients had undergone coronary angiography as part of pretransplant cardiac evaluation. We determined prevalence of coronary artery disease and Gensini score (which indicates extent of coronary artery disease) using coronary angiography and reviewed MELD-XI score and in-hospital mortality rates. We compared MELD-XI score and Gensini score in deceased and surviving patients and correlated both scores with mortality and with each other. RESULTS Of 121 patients, 79 (65.3%) were men; mean age of the study population was 59.6 ± 10.2 years. Twenty-eight patients (23.1%) had coronary artery disease, and 13 (10.7%) had severe coronary artery disease on coronary angiography. Twenty-three patients (19%) died while on the transplant wait list. Gensini score and MELD-XI scores were significantly higher in those who died (P < .05). MELD-XI score, but not Gensini score, was a significant independent predictor of death among patients awaiting liver transplant (hazard ratio = 1.35; 95% confidence interval, 1.04-1.78; P < .05). CONCLUSIONS MELD-XI score independently predicted in-hospital death among patients scheduled to undergo liver transplant. These patients also had increased prevalence and extent of coronary artery disease.
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Affiliation(s)
- Suzan Keskin
- From the Department of Cardiology, Başkent University Faculty of Medicine, Ankara, Turkey
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5
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Wernly B, Frutos-Vivar F, Peñuelas O, Raymondos K, Muriel A, Du B, Thille AW, Ríos F, González M, Del-Sorbo L, Del Carmen Marín M, Pinheiro BV, Soares MA, Nin N, Maggiore SM, Bersten A, Kelm M, Amin P, Cakar N, Lichtenauer M, Suh GY, Abroug F, Jibaja M, Matamis D, Zeggwagh AA, Sutherasan Y, Anzueto A, Esteban A, Jung C. Easy prognostic assessment of concomitant organ failure in critically ill patients undergoing mechanical ventilation. Eur J Intern Med 2019; 70:18-23. [PMID: 31606309 DOI: 10.1016/j.ejim.2019.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 08/25/2019] [Accepted: 09/02/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND Acute respiratory distress syndrome (ARDS) is a life-threatening disease. We evaluated the prognostic utility of Model for End-stage Liver Disease excluding INR (MELD-XI) score for predicting mortality in a cohort of critically ill patients on mechanical ventilation. METHODS In total, 11,091 mechanically ventilated patients were included in our post-hoc retrospective analysis, a subgroup of the VENTILA study (NCT02731898). Evaluation of associations with mortality was done by logistic and Cox regression analysis, an optimal cut-off was calculated using the Youden Index. We divided the cohort in two sub-groups based on their MELD-XI score at the optimal cut-off (12 score points). RESULTS Peak-, plateau- and positive end-expiratory pressure were higher in patients with MELD-XI>12. Patients with MELD-XI>12 had higher driving pressures (14 ± 6 cmH2O versus 13 ± 6; p < 0.001). MELD-XI was associated with 28-day mortality after correction for relevant cofounders including SAPS II and ventilation pressures (HR 1.04 95%CI 1.03-1.05; p < 0.001. Patients with MELD-XI>12 evidenced both increased hospital (46% versus 27%; p < 0.001) and 28-day mortality (39% versus 22%). CONCLUSIONS MELD-XI is independently associated with mortality and constitutes a useful and easily applicable tool for risk stratification in critically ill patients receiving mechanical ventilation. TRIAL REGISTRATION NCT02731898, registered 4 April 2016.
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Affiliation(s)
- Bernhard Wernly
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, Salzburg 5020, Austria.
| | - Fernando Frutos-Vivar
- Hospital Universitario de Getafe & Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Spain.
| | - Oscar Peñuelas
- Hospital Universitario de Getafe & Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Spain
| | | | - Alfonso Muriel
- Hospital Universitario de Getafe & Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Spain; Unidad de Bioestadística Clinica Hospital Ramón y Cajal, Instituto Ramón y Cajal de Investigaciones Sanitarias (IRYCIS) & Centro de Investigación en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
| | - Bin Du
- Peking Union Medical College Hospital, Beijing, PR China
| | | | - Fernando Ríos
- Hospital Nacional Alejandro Posadas, Buenos Aires, Argentina
| | - Marco González
- Clínica Medellín & Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Lorenzo Del-Sorbo
- Interdepartmental Division of Critical Care Medicine, Toronto, ON, Canada.
| | - Maria Del Carmen Marín
- Hospital Regional 1° de Octubre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), México, DF, Mexico
| | | | | | | | | | - Andrew Bersten
- Department of Critical Care Medicine, Flinders University, Adelaide, South Australia, Australia.
| | - Malte Kelm
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University of Düsseldorf, Düsseldorf 40225, Germany.
| | - Pravin Amin
- Bombay Hospital Institute of Medical Sciences, Mumbai, India.
| | - Nahit Cakar
- Department of Anesthesiology and Reanimation, Koç University Faculty of Medicine, İstanbul-Turkey
| | - Michael Lichtenauer
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, Salzburg 5020, Austria.
| | - Gee Young Suh
- Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | | | - Manuel Jibaja
- Unidad de Cuidados Intensivos, Hospital Eugenio Espejo, Escuela de Medicina, Universidad Internacional del Ecuador, Quito
| | | | - Amine Ali Zeggwagh
- Centre Hospitalier Universitarie Ibn Sina, Mohammed V University, Rabat, Morocco.
| | - Yuda Sutherasan
- Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Antonio Anzueto
- Division of Pulmonary Diseases & Critical Care Medicine, The University of Texas Health Science Centre at San Antonio, San Antonio, TX, USA.
| | - Andrés Esteban
- Hospital Universitario de Getafe & Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Spain.
| | - Christian Jung
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University of Düsseldorf, Düsseldorf 40225, Germany.
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Soldera J, Camazzola F, Rodríguez S, Brandão A. Cardiac stress testing and coronary artery disease in liver transplantation candidates: Meta-analysis. World J Hepatol 2018; 10:877-886. [PMID: 30533188 PMCID: PMC6280161 DOI: 10.4254/wjh.v10.i11.877] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 09/13/2018] [Accepted: 10/11/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the diagnostic value of dobutamine stress echocardiography (DSE) and myocardial perfusion scintigraphy (MPS) in predicting coronary artery disease (CAD) in cirrhotic patients listed for liver transplantation (LT), using invasive coronary angiography (ICA) as gold-standard. METHODS Retrieval of studies was based on Medical Subject Headings and Health Sciences Descriptors, which were combined using Boolean operators. Searches were run on the electronic databases Scopus, Web of Science, EMBASE, MEDLINE (PubMed), BIREME (Biblioteca Regional de Medicina), LILACS (Latin American and Caribbean Health Sciences Literature), Cochrane Library for Systematic Reviews and Opengray.eu. There was no language or date of publication restrictions. The reference lists of the studies retrieved were searched manually. RESULTS The search strategy retrieved 322 references for DSE and 90 for MPS. In the final analysis, 10 references for DSE and 10 for MPS were included. Pooled sensitivity was 28% and 61% for DSE and MPS and specificity was 82% and 74%, for diagnosis of CAD using ICA as gold-standard, respectively. CONCLUSION DSE and MPS do not have adequate sensitivity for determination of whether CAD is present, despite having significant specificity.
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Affiliation(s)
- Jonathan Soldera
- School of Medicine, Universidade de Caxias do Sul (UCS), Caxias do Sul 95070-560, Brazil
- School of Medicine, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre 90050-170, Brazil.
| | - Fábio Camazzola
- School of Medicine, Universidade de Caxias do Sul (UCS), Caxias do Sul 95070-560, Brazil
| | - Santiago Rodríguez
- School of Medicine, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre 90050-170, Brazil
| | - Ajacio Brandão
- School of Medicine, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre 90050-170, Brazil
- Liver Transplantation Group, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre 90020-090, Brazil
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Wernly B, Lichtenauer M, Vellinga N, Boerma C, Ince C, Kelm M, Jung C. Model for End-Stage Liver Disease Excluding INR (MELD-XI) score is associated with hemodynamic impairment and predicts mortality in critically ill patients. Eur J Intern Med 2018; 51:80-84. [PMID: 29572092 DOI: 10.1016/j.ejim.2018.01.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 01/10/2018] [Accepted: 01/29/2018] [Indexed: 12/29/2022]
Abstract
PURPOSE We aimed (i) to evaluate Model for End-stage Liver Disease excluding INR (MELD-XI) score for prediction of mortality in a cohort of critically ill patients and (ii) to investigate associations of MELD-XI with microcirculation and (iii) to evaluate microcirculation for prediction of mortality in high-risk patients, e.g., with high MELD-XI scores. METHODS 308 patients were included in our retrospective analysis, a subgroup of the multicenter micro-SOAP-study. Microcirculation was evaluated by Sidestream Dark Field (SDF) imaging. Evaluation of associations with mortality was done by logistic regression analysis, an optimal cut-off was calculated by means of the Youden Index. We divided the cohort in two sub-groups based on their MELD-XI score at the optimal cut-off (12 score points). RESULTS Patients with a MELD-XI > 12 points were of similar age (60 ± 1 years vs 62 ± 2 years; p = 0.32), but clinically sicker as mirrored by higher APACHE II scores (20 ± 1 vs 16 ± 1; p < 0.001). In the MELD-XI > 12 cohort in-hospital mortality was significantly higher compared to the MELD ≤ 12 group (48% vs 24%%; HR 2.98 95%CI 1.76-5.04; p = 0.003) and MELD-XI score was associated with mortality even after correction for relevant clinical confounders (HR 1.04 95%CI 1.01-1.07; p = 0.004) There were no associations between MELD-XI and parameters of microvascular perfusion. CONCLUSIONS MELD-XI is associated with in-hospital mortality and constitutes a useful tool for risk stratification in intensive care medicine. Interestingly, there were no associations between MELD-XI and microcirculation. Possibly parameters of the microcirculation present an online tool of hemodynamic assessment while MELD-XI presents an assessment of already established organ failure.
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Affiliation(s)
- Bernhard Wernly
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, Austria.
| | - Michael Lichtenauer
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, Austria.
| | - Namkje Vellinga
- Department of Intensive Care, Medisch Centrum Leeuwarden, Leeuwarden, The Netherlands
| | - Christiaan Boerma
- Department of Intensive Care, Medisch Centrum Leeuwarden, Leeuwarden, The Netherlands
| | - Can Ince
- Department of Physiology, Academic Medical Center, University of Amsterdam, The Netherlands.
| | - Malte Kelm
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Duesseldorf, Germany.
| | - Christian Jung
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Duesseldorf, Germany.
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8
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Soldera J, Camazzola F, Rodríguez S, Brandão A. Dobutamine stress echocardiography, myocardial perfusion scintigraphy, invasive coronary angiography, and post-liver transplantation events: Systematic review and meta-analysis. Clin Transplant 2018; 32:e13222. [PMID: 29436036 DOI: 10.1111/ctr.13222] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2018] [Indexed: 12/15/2022]
Abstract
The impact of coronary artery disease on the clinical course of patients enrolled for liver transplantation (LT) has changed over the years as these patients become older and sicker. The purpose of this systematic review and meta-analysis was to investigate the value of dobutamine stress echocardiography (DSE), myocardial perfusion scintigraphy (MPS), and invasive coronary angiography (ICA) in predicting cardiac events post-LT in cirrhotic patients. A literature search was conducted using Scopus, Web of Science, EMBASE, MEDLINE (via PubMed), BIREME (regional medical library of the Pan American Health Organization), LILACS (Latin American and Caribbean Health Sciences Literature), Cochrane Library for Systematic Reviews, and OpenGrey Repository (www.opengrey.eu) electronic databases. A total of 322 records were retrieved for DSE, 90 for MPS, and 149 for ICA. In the final analysis, 11 records for DSE, 7 for MPS, and 8 for ICA were included. The relative risk and confidence interval for major adverse cardiac events were 30.2 (2.8-325.4) for DSE, 2.6 (1.09-6.1) for MPS, and 2.1 (1.0-2.3) for ICA, while the relative risk and confidence interval for all-cause mortality was 4.7 for DSE (1.8-12.0), 2.7 (1.25-5.9) for MPS, and 1.5 (0.89-3.2) for ICA. In conclusion, this meta-analysis found that DSE, MPS, and ICA do not satisfactorily predict increased risk of perioperative MACE or all-cause mortality among cirrhotic patients listed for LT, among small and heterogenous studies.
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Affiliation(s)
- Jonathan Soldera
- Graduate Program in Medicine: Hepatology, School of Medicine, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil.,School of Medicine, Universidade de Caxias do Sul (UCS), Caxias do Sul, RS, Brazil
| | - Fábio Camazzola
- School of Medicine, Universidade de Caxias do Sul (UCS), Caxias do Sul, RS, Brazil
| | - Santiago Rodríguez
- Graduate Program in Medicine: Hepatology, School of Medicine, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Ajacio Brandão
- Graduate Program in Medicine: Hepatology, School of Medicine, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil.,Liver Transplantation Group, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil
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Testoni I, Milo V, Ronconi L, Feltrin A, Zamperini A, Rodelli M, Germani G, Cillo U. Courage and representations of death in patients who are waiting for a liver transplantation. COGENT PSYCHOLOGY 2017. [DOI: 10.1080/23311908.2017.1294333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Ines Testoni
- Department of Philosophy, Sociology, Pedagogy and Applied Psychology (FISPPA), University of Padova, Via Venezia 14, 35131 Padova, Italy
| | - Valentina Milo
- Department of Philosophy, Sociology, Pedagogy and Applied Psychology (FISPPA), University of Padova, Via Venezia 14, 35131 Padova, Italy
| | - Lucia Ronconi
- Department of Philosophy, Sociology, Pedagogy and Applied Psychology (FISPPA), University of Padova, Via Venezia 14, 35131 Padova, Italy
| | - Alessandra Feltrin
- Psychological Unit, Padova University Hospital, Via Giustiniani 2, 35131 Padova, Italy
| | - Adriano Zamperini
- Department of Philosophy, Sociology, Pedagogy and Applied Psychology (FISPPA), University of Padova, Via Venezia 14, 35131 Padova, Italy
| | - Maddalena Rodelli
- Department of Philosophy, Sociology, Pedagogy and Applied Psychology (FISPPA), University of Padova, Via Venezia 14, 35131 Padova, Italy
| | - Giacomo Germani
- Multivisceral Transplant Unit, Padova University Hospital, Via Giustiniani 2, 35131 Padova, Italy
| | - Umberto Cillo
- Hepatobiliary Surgery and Liver Transplantation Unit, Padova University Hospital, Via Giustiniani 2, 35131 Padova, Italy
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Wernly B, Lichtenauer M, Franz M, Kabisch B, Muessig J, Masyuk M, Hoppe UC, Kelm M, Jung C. Model for End-stage Liver Disease excluding INR (MELD-XI) score in critically ill patients: Easily available and of prognostic relevance. PLoS One 2017; 12:e0170987. [PMID: 28151948 PMCID: PMC5289507 DOI: 10.1371/journal.pone.0170987] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 01/13/2017] [Indexed: 12/29/2022] Open
Abstract
Purpose MELD-XI, an adapted version of Model for End-stage Liver Disease (MELD) score excluding INR, was reported to predict outcomes e.g. in patients with acute heart failure. We aimed to evaluate MELD-XI in critically ill patients admitted to an intensive care unit (ICU) for prognostic relevance. Methods A total of 4381 medical patients (66±14 years, 2862 male) admitted to a German ICU between 2004 and 2009 were included and retrospectively investigated. Admission diagnoses were e.g. myocardial infarction (n = 2034), sepsis (n = 694) and heart failure (n = 688). We divided our patients in two cohorts basing on their MELD-XI score and evaluated the MELD-XI score for its prognostic relevance regarding short-term and long-term survival. Optimal cut-offs were calculated by means of the Youden-Index. Results Patients with a MELD-XI score >12 had pronounced laboratory signs of organ failure and more comorbidities. MELD-XI >12 was associated with an increase in short-term (27% vs 6%; HR 4.82, 95%CI 3.93–5.93; p<0.001) and long-term (HR 3.69, 95%CI 3.20–4.25; p<0.001) mortality. In a univariate Cox regression analysis for all patients MELD-XI was associated with increased long-term mortality (changes per score point: HR 1.06, 95%CI 1.05–1.07; p<0.001) and remained to be associated with increased mortality after correction in a multivariate regression analysis for renal failure, liver failure, lactate concentration, blood glucose concentration, oxygenation and white blood count (HR 1.04, 95%CI 1.03–1.06; p<0.001). Optimal cut-off for the overall cohort was 11 and varied remarkably depending on the admission diagnosis: myocardial infarction (9), pulmonary embolism (9), cardiopulmonary resuscitation (17) and pneumonia (17). We performed ROC-analysis and compared the AUC: SAPS2 (0.78, 95%CI 0.76–0.80; p<0.0001) and APACHE (0.76, 95%CI 0.74–0.78; p<0.003) score were superior to MELD-XI (0.71, 95%CI 0.68–0.73) for prediction of mortality. Conclusions The easily calculable MELD-XI score is a robust and reliable tool to predict both intra-ICU and long-term mortality in critically ill medical patients admitted to an ICU. Optimal cut-off values for MELD-XI scores seem to depend on the primary disease and need to be validated in future prospective studies. Compared to SAPS2 and APACHE score, MELD-XI lacks precision but might have comparable and even additive value, as it is easily available and independent of subjective values.
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Affiliation(s)
- Bernhard Wernly
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, Salzburg Austria
| | - Michael Lichtenauer
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, Salzburg Austria
| | - Marcus Franz
- Clinic of Internal Medicine I, Department of Cardiology, Jena University Hospital, Jena, Germany
| | - Bjoern Kabisch
- Clinic of Internal Medicine I, Department of Cardiology, Jena University Hospital, Jena, Germany
| | - Johanna Muessig
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Duesseldorf, Duesseldorf, Germany
| | - Maryna Masyuk
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Duesseldorf, Duesseldorf, Germany
| | - Uta C Hoppe
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, Salzburg Austria
| | - Malte Kelm
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Duesseldorf, Duesseldorf, Germany
| | - Christian Jung
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Duesseldorf, Duesseldorf, Germany
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Gibney KB, Cheng AC, Hall R, Leder K. Sociodemographic and geographical inequalities in notifiable infectious diseases in Australia: a retrospective analysis of 21 years of national disease surveillance data. THE LANCET. INFECTIOUS DISEASES 2016; 17:86-97. [PMID: 27789179 DOI: 10.1016/s1473-3099(16)30309-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 07/20/2016] [Accepted: 07/29/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Australia is a high-income country with a well established and largely publicly funded health-care system. However, some populations within Australia have shorter life expectancy and worse health outcomes than others. We explored geographical variations and sociodemographic inequities in infectious disease notifications in Australia. METHODS In this retrospective study, we analysed National Notifiable Diseases Surveillance System (NNDSS) notifications from 1991-2011 (n=2·4 million). We assessed the effect of socioeconomic disadvantage and remoteness of residence on national notification incidence. We calculated Gini coefficients, adjusted relative risks (aRRs), population attributable fractions (PAFs), and attributable notifications. We reported aRRs for Indigenous status in three jurisdictions with more than 75% completeness of Indigenous status reporting from the Northern Territory, South Australia, and Western Australia. FINDINGS Of the eight most commonly notified diseases from Jan 1, 1991, to Dec 31, 2011, gonococcal infection was the most geographically unequal and campylobacteriosis was the most evenly distributed across the country. Overall, notification incidence was higher in remote and very remote areas than in major cities (aRR 3·37), and higher in the most socioeconomically disadvantaged quintiles compared with less disadvantaged quintiles (aRR 1·15). The PAF for socioeconomic disadvantage was high for blood-borne viral hepatitis but decreased in other disease groups. In 2011, sexually transmitted infections had 11 093 notifications attributed to remoteness and 5597 notifications attributable to socioeconomic disadvantage. Notification incidence was higher in Indigenous than in non-Indigenous Australians (aRR 5·3). INTERPRETATION All diseases had differing geographical concentration and sociodemographic risk. Overall, sociodemographic inequities in infectious disease notifications have decreased, but remain unacceptably high. National communicable disease control is complex, requiring both targeted and population-wide interventions. FUNDING None.
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Affiliation(s)
- Katherine B Gibney
- Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre, Melbourne, VIC, Australia; Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC, Australia; Royal Melbourne Hospital, Melbourne, VIC, Australia.
| | - Allen C Cheng
- Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre, Melbourne, VIC, Australia
| | - Robert Hall
- Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre, Melbourne, VIC, Australia
| | - Karin Leder
- Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre, Melbourne, VIC, Australia
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