![]() ![]() It has been developed and validated to predict mortality in patients with portal hypertension undergoing placement of transjugular intrahepatic portosystemic shunts. The well-established MELD score depends on 3 readily available laboratory variables, that is, serum creatinine, serum bilirubin, and the international normalized ratio (INR). The laboratory-based model for end-stage liver disease (MELD) score reflects the function of the kidney, liver, and extrinsic coagulation pathway and might be used as a general prognostic tool for the assessment of patients. We suggest to prospectively validate the MELD score in inpatients as part of clinical decision support systems.Ĭlinical decision support systems have been shown to improve the quality of patient care and to reduce health care costs however, little is known about their overall impact on patient outcomes. In our study population consisting of adult inpatients, the MELD score on hospital admission was significantly associated with mortality, LOS, and the number of comorbidities. Increased MELD scores of 15 to 19, 20 to 29, and ≥30 points were positively associated with LOS and the number of comorbidities in uni- and multivariable analysis. The primary outcome measure was in-hospital all-cause mortality secondary outcome measures were LOS and the number of comorbidities.Ī total of 39,323 inpatients were included in the final analysis. ![]() The MELD score on hospital admission was calculated retrospectively. From January 2012 through December 2013, all consecutive inpatients aged 18 years were eligible for the study patients with missing MELD parameters on hospital admission and/or treatments influencing the international normalized ratio, that is, novel oral anticoagulants and vitamin K antagonists, were excluded. We performed a retrospective observational study at a tertiary referral center. We therefore aimed to investigate a potential association of the MELD score with mortality, length of hospital stay (LOS), and disease burden in a general patient population. This population-wide study shows that the MELD score and the serum sodium concentration are important predictors of survival among candidates for liver transplantation.The laboratory-based model for end-stage liver disease (MELD) score reflects the function of the kidney, liver, and extrinsic coagulation pathway and might be used as a general prognostic tool for the assessment of patients. Thus, assignment of priority according to the MELD score combined with the serum sodium concentration might have resulted in transplantation and prevented death. ![]() When applied to the data from 2006, when 477 patients died within 3 months after registration on the waiting list, the combination of the MELD score and the serum sodium concentration was considerably higher than the MELD score alone in 32 patients who died (7%). Furthermore, a significant interaction was found between the MELD score and the serum sodium concentration, indicating that the effect of the serum sodium concentration was greater in patients with a low MELD score. Both the MELD score and the serum sodium concentration were significantly associated with mortality (hazard ratio for death, 1.21 per MELD point and 1.05 per 1-unit decrease in the serum sodium concentration for values between 125 and 140 mmol per liter P<0.001 for both variables). In 2005, there were 6769 registrants, including 1781 who underwent liver transplantation and 422 who died within 90 days after registration on the waiting list. The MELD score (on a scale of 6 to 40, with higher values indicating more severe disease) is calculated on the basis of the serum bilirubin and creatinine concentrations and the international normalized ratio for the prothrombin time. The predictor variable was the Model for End-Stage Liver Disease (MELD) score with and without the addition of the serum sodium concentration. Using data derived from all adult candidates for primary liver transplantation who were registered with the Organ Procurement and Transplantation Network in 20, we developed and validated a multivariable survival model to predict mortality at 90 days after registration. Under the current liver-transplantation policy, donor organs are offered to patients with the highest risk of death.
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