The Predictive Value of the MELD Scores for In-Hospital Adverse Events in Normotensive Patients with Acute Pulmonary Embolism

Author:

Jiao Siqi1ORCID,Liu Ying2,He Haoming3,Li Qing1,Wang Zhe3,Chen Yinong1,Zhu Longyang1,Zheng Shuwen4,Yang Furong4,Zhai Zhenguo567,Sun Yihong8

Affiliation:

1. Peking University Health Science Center, China–Japan Friendship Hospital, Beijing, China

2. Beijing Ditan Hospital, Capital Medical University, Beijing, China

3. Department of Cardiology, China–Japan Friendship Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China

4. School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China

5. Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China–Japan Friendship Hospital, Beijing, China

6. Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China

7. Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China–Japan Friendship Hospital, National Clinical Research Center for Respiratory Diseases, Beijing, China

8. Department of Cardiology, China–Japan Friendship Hospital, Beijing, China

Abstract

The model for end-stage liver disease (MELD) and the model for end-stage liver disease excluding international normalized ratio (INR) (MELD-XI) scores, which reflect dysfunction of liver and kidneys, have been reported to be related to the prognosis of patients with right-sided “backward” failure. However, the relationship between the MELD/MELD-XI score and the in-hospital adverse events in pulmonary embolism (PE) patients was unknown. Normotensive PE patients were retrospectively enrolled at China–Japan friendship hospital from January 2017 to February 2020. The primary outcome was defined as death and clinical deterioration during hospitalization. Multivariate logistic analysis was used to explore the association between the MELD and MELD-XI scores for in-hospital adverse events. We also compared the accuracy of the MELD, MELD-XI, and the pulmonary embolism severity index (PESI) score using the time-dependent receiver operating characteristic curve and corresponding areas under the curve (AUC). A total of 222 PE patients were analyzed. Logistic regression analysis showed that the MELD score was independently associated with in-hospital adverse events (odds ratio = 1.115, 95% confidential interval = 1.022-1.217, P = .014). The MELD score has an AUC of 0.731 and was better than PESI (AUC of 0.629) in predicting in-hospital adverse events. Among PE patients with normal blood pressure on admission, the MELD score was associated with increased in-hospital adverse events.

Funder

the Capital Health Research and Development of Special Fund

Publisher

SAGE Publications

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