J. O. Hwabejire1, C. Nembhard1, E. Cornwell1, W. Greene1 1Howard University College Of Medicine,Washington, DC, USA
Introduction: The Model for End-Stage Liver Disease (MELD) score has been shown to predict mortality in cirrhotic trauma patients. We examined the association of the MELD score in patients without liver disease who sustained traumatic hemorrhagic shock.
Methods: The Inflammation and the Host Response to Injury database was analyzed. Patients with complete parameters for calculating the MELD score were included, while those with pre-existing liver disease were excluded. Subjects were stratified into 3 groups: MELD I (MELD score ≤10), MELD II (MELD score >10 and ≤20) and MELD III (MELD score >20). Logistic regression analysis was used to evaluate the association between mortality and the MELD score.
Results: A total of 183 patients were included, with a mean age of 43 years, and males making 68% of the study group. The mean MELD score and in-hospital mortality of the study cohort were 12.5 ± 5.9 and 18.0%, respectively. MELD I had a mortality of 9.4%, with 6.3% and
15.6% of them developing abdominal compartment syndrome (ACS) and acute respiratory distress syndrome (ARDS), respectively. The mortality for MELD II was 22.0%, with 11.0% and 38.0% of subjects developing ACS and ARDS respectively. MELD III had a mortality of 26.3%, with 15.8% and 31.6% of subjects ACS and ARDS, respectively. The MELD score was associated with mortality (OR: 1.073, CI: 1.010-1.140, p=0.021), with a 7.3% increase in mortality for every unit increase in MELD score.
Conclusion: In non-cirrhotic patients who sustained traumatic hemorrhagic shock, increased MELD score is associated with increased mortality. Whether optimization of liver function following hemorrhagic shock would improve outcome deserves further investigations