• Bernhard Wernly, Fernando Frutos-Vivar, Oscar Peñuelas, Konstantinos Raymondos, Alfonso Muriel, Bin Du, Arnaud W Thille, Fernando Ríos, Marco González, Lorenzo Del-Sorbo, Maria Del Carmen Marín, Bruno Valle Pinheiro, Marco Antonio Soares, Nicolas Nin, Salvatore M Maggiore, Andrew Bersten, Malte Kelm, Pravin Amin, Nahit Cakar, Michael Lichtenauer, Gee Young Suh, Fekri Abroug, Manuel Jibaja, Dimitros Matamis, Amine Ali Zeggwagh, Yuda Sutherasan, Antonio Anzueto, Andrés Esteban, and Christian Jung.
• Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, Salzburg 5020, Austria. Electronic address: bernhard@wernly.at.
• Eur. J. Intern. Med. 2019 Dec 1; 70: 18-23.

BackgroundAcute 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.MethodsIn 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).ResultsPeak-, 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%).ConclusionsMELD-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 RegistrationNCT02731898, registered 4 April 2016.Copyright © 2019 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

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