Meld calculator11/3/2023 As the kidney is depending on constant and adequate blood flow it effectively mirrors states of global hypoperfusion and venous congestion, conditions which are common in critically ill patients. Recently liver function has been reported to predict survival in surgical patients undergoing extracorporal membrane oxygenation, and hepato-cardiac comorbidities have come into the spotlight for risk stratification of those critically ill patients. Increased serum total bilirubin is known to be linked with hepatocellular hypoxia originating from low cardiac output and/or increased hepatic venous pressure. Liver dysfunction and elevations in the associated serum markers are known to be related to poor outcomes in many patient collectives. The MELD score captures derangements in two critical organ systems: kidney and liver. The score is currently used in the allocation of organs for patients waiting for liver transplantation as it also correlates significantly with waiting list mortality. It has been shown that the MELD score can serve as an indicator of multi-organ failure. It utilizes a logarithmic function including serum creatinine, total serum bilirubin and the International Normalized Ratio (INR). In a plethora of studies, the utility of the Model for End-Stage Liver Disease (MELD) score has been evaluated as a predictor for clinical outcome in patients suffering from liver disease. Scoring systems (such as APACHE 2 and SAPS2) have been developed to better stratify the risk profiles of ICU patients and to estimate their potential outcome. They largely differ in terms of clinical presentation, age, disease etiology, hemodynamics, treatment response as well as in prognosis. Patients admitted to an intensive care unit (ICU) represent a highly heterogeneous population. 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). 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). Patients with a MELD-XI score >12 had pronounced laboratory signs of organ failure and more comorbidities.
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