Early evaluation of organ failure using MELD-XI in critically ill elderly COVID-19 patients

Raphael Romano Bruno, Bernhard Wernly, Johanna Hornemann, Hans Flaatten, Jesper Fjølner, Antonio Artigas, Bernardo Bollen Pinto, Joerg C. Schefold, Georg Wolff, Philipp Heinrich Baldia, Stephan Binneboessel, Malte Kelm, Michael Beil, Sigal Sviri, Peter Vernon Van Heerden, Wojciech Szczeklik, Muhammed Elhadi, Michael Joannidis, Sandra Oeyen, Eumorfia KondiliJakob Wollborn, Brian Marsh, Finn H. Andersen, Rui Moreno, Susannah Leaver, Ariane Boumendil, Dylan W. De Lange, Bertrand Guidet, Christian Jung

Research output: Contribution to journalArticlepeer-review

Abstract

PURPOSE: Critically ill elderly patients who suffer from Sars-CoV-2 disease are at high risk for organ failure. The modified MELD-XI score has not been evaluated for outcome prediction in these most vulnerable patients. METHODS: The Corona Virus disease (COVID19) in Very Elderly Intensive Care Patients study (COVIP, NCT04321265) prospectively recruited patients on intensive care units (ICU), who were≥70 years. Data were collected from March 2020 to February 2021. The MELD-XI score was calculated using the highest serum bilirubin and creatinine on ICU admission. Univariate and multivariable logistic regression analyses were performed to assess associations between the MELD-XI score and mortality. The primary outcome was 30-day-mortality, the secondary outcomes were ICU- and 3-month-mortality. RESULTS: In total, data from 2,993 patients were analyzed. Most patients had a MELD-XI <12 on admission (76%). The patients with MELD-XI≥12 had a significantly higher 30-day-, ICU- and 3-month-mortality (44% vs 64%, and 42% vs. 59%, and 57% vs. 76%, p < 0.001). After adjustment for multiple confounders, MELD-XI≥12 remained significantly associated with 30-day- (aOR 1.572, CI 1.268-1.949, p < 0.001), ICU-, and 3-month-mortality. CONCLUSION: In critically ill elderly intensive care patients with COVID-19, the MELD-XI score constitutes a valuable tool for an early outcome prediction.

Original languageEnglish
Pages (from-to)109-120
Number of pages12
JournalClinical Hemorheology and Microcirculation
Volume79
Issue number1
DOIs
Publication statusPublished - 2021

Keywords

  • COVID-19
  • Elderly
  • Intensive care medicine
  • MELD-XI

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