Establishment of MELD-lactate clearance scoring system in predicting death risk of critically ill cirrhotic patients

Xin Li, Man Gong, Shuangnan Fu, Jingjing Zhang, Shanbin Wu, Xin Li, Man Gong, Shuangnan Fu, Jingjing Zhang, Shanbin Wu

Abstract

Background: To develop a scoring system related to the lactate clearance (ΔLA) to predict the mortality risk (MELD-ΔLA) for critically ill cirrhotic patients.

Methods: In this retrospective cohort study, 881 critically ill cirrhotic patients from the Medical Information Mart for Intensive Care (MIMIC-III) database were included eventually. The outcomes of our study were defined as ICU death, 28-day, 90-day and 1-year mortality. Predictors were identified by multivariate Cox analysis to develop the predictive scoring system. The C-index and area under the curve (AUC) of receiver operator characteristic curve (ROC) were used to identify the predicting performance of the MELD-ΔLA, sequential organ failure assessment (SOFA), chronic liver failure-sequential organ failure assessment (CLIF-SOFA), the model for end-stage liver disease (MELD), Child-Pugh, chronic liver failure consortium acute-on-chronic liver failure (CLIF-C ACLF), chronic liver failure consortium-acute decompensation (CLIF-C AD) and MELD-Na scoring systems. Additionally, subgroup analysis was also performed based on whether critically ill cirrhotic patients underwent liver transplantation.

Results: Creatinine, bilirubin, international normalized ratio (INR), lactate first, ΔLA and vasopressors were closely associated with ICU death of liver critically ill cirrhotic patients. The C-index of the MELD-ΔLA in ICU death was 0.768 (95% CI 0.736-0.799) and the AUC for the MELD-ΔLA scoring system in predicting 28-day, 90-day, and 1-year mortality were 0.774 (95% CI 0.743-0.804), 0.765 (95% CI 0.735-0.796), and 0.757 (95% CI 0.726-0.788), suggested that MELD-ΔLA scoring system has a good predictive value than SOFA, CLIF-SOFA, MELD, Child-Pugh, CLIF-C ACLF, CLIF-C AD) and MELD-Na scoring systems. Additionally, the study also confirmed the good predictive value of MELD-ΔLA scoring system for critically ill cirrhotic patients regardless of undergoing liver transplantation.

Conclusion: The developed MELD-ΔLA score is a simple scoring system in predicting the risk of ICU death, 28-day, 90-day and 1-year mortality for critically ill cirrhotic patients, which may have a good predictive performance.

Keywords: Critically ill cirrhotic patients; ICU death; Lactate clearance; MELD-ΔLA score.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
The association of MELD-ΔLA score and ICU death, 28-day, 90-day and 1-year mortality in liver cirrhosis patients
Fig. 2
Fig. 2
ROC curves of (a) 28-day, (b) 90-day, and (c) 1-year death for MELD-ΔLA score

References

    1. Moon AM, Singal AG, Tapper EB. Contemporary epidemiology of chronic liver disease and cirrhosis. Clin Gastroenterol Hepatol. 2020;18(12):2650–2666. doi: 10.1016/j.cgh.2019.07.060.
    1. Weil D, Levesque E, McPhail M, Cavallazzi R, Theocharidou E, Cholongitas E, et al. Prognosis of cirrhotic patients admitted to intensive care unit: a meta-analysis. Ann Intensive Care. 2017;7(1):33. doi: 10.1186/s13613-017-0249-6.
    1. Wan SZ, Nie Y, Zhang Y, Liu C, Zhu X. Assessing the prognostic performance of the child-pugh, model for end-stage liver disease, and albumin-bilirubin scores in patients with decompensated cirrhosis: a large asian cohort from gastroenterology department. Dis Markers. 2020;2020:5193028. doi: 10.1155/2020/5193028.
    1. McPhail MJ, Shawcross DL, Abeles RD, Chang A, Patel V, Lee GH, et al. Increased survival for patients with cirrhosis and organ failure in liver intensive care and validation of the chronic liver failure-sequential organ failure scoring system. Clin Gastroenterol Hepatol. 2015;13(7):1353–60.e8. doi: 10.1016/j.cgh.2014.08.041.
    1. Pan HC, Jenq CC, Tsai MH, Fan PC, Chang CH, Chang MY, et al. Scoring systems for 6-month mortality in critically ill cirrhotic patients: a prospective analysis of chronic liver failure—sequential organ failure assessment score (CLIF-SOFA) Aliment Pharmacol Ther. 2014;40(9):1056–1065. doi: 10.1111/apt.12953.
    1. Francoz C, Belghiti J, Castaing D, Chazouillères O, Duclos-Vallée JC, Duvoux C, et al. Model for end-stage liver disease exceptions in the context of the French model for end-stage liver disease score-based liver allocation system. Liver Transpl. 2011;17(10):1137–1151. doi: 10.1002/lt.22363.
    1. Kuo CC, Huang CH, Chang C, Chen PC, Chen BH, Chen WT, Ho YP. Comparing CLIF-C ACLF, CLIF-C ACLFlactate, and CLIF-C ACLF-D prognostic scores in acute-on-chronic liver failure patients by a single-center ICU experience. J Pers Med. 2021;11(2):79. doi: 10.3390/jpm11020079.
    1. Goudsmit BFJ, Putter H, Tushuizen ME, de Boer J, Vogelaar S, Alwayn IPJ, et al. Validation of the model for end-stage liver disease sodium (MELD-Na) score in the Eurotransplant region. Am J Transplant. 2021;21(1):229–240. doi: 10.1111/ajt.16142.
    1. Sarmast N, Ogola GO, Kouznetsova M, Leise MD, Bahirwani R, Maiwall R, et al. Model for end-stage liver disease-lactate and prediction of inpatient mortality in patients with chronic liver disease. Hepatology. 2020;72(5):1747–1757. doi: 10.1002/hep.31199.
    1. Mahmud N, Asrani SK, Kaplan DE, Ogola GO, Taddei TH, Kamath PS, et al. The predictive role of model for end-stage liver disease-lactate and lactate clearance for in-hospital mortality among a national cirrhosis cohort. Liver Transpl. 2021;27(2):177–189. doi: 10.1002/lt.25913.
    1. Nie Y, Zhang Y, Liu LX, Zhu X. Serum lactate level predicts short-term and long-term mortality of HBV-ACLF patients: a prospective study. Ther Clin Risk Manag. 2020;16:849–860. doi: 10.2147/TCRM.S272463.
    1. Drolz A, Horvatits T, Rutter K, Landahl F, Roedl K, Meersseman P, et al. Lactate improves prediction of short-term mortality in critically Ill patients with cirrhosis: a multinational study. Hepatology. 2019;69(1):258–269. doi: 10.1002/hep.30151.
    1. Tas A, Akbal E, Beyazit Y, Kocak E. Serum lactate level predict mortality in elderly patients with cirrhosis. Wien Klin Wochenschr. 2012;124(15–16):520–525. doi: 10.1007/s00508-012-0208-z.
    1. Vincent JL, Quintairos ESA, Couto L, Jr, Taccone FS. The value of blood lactate kinetics in critically ill patients: a systematic review. Crit Care. 2016;20(1):257. doi: 10.1186/s13054-016-1403-5.
    1. Zhang Z, Xu X. Lactate clearance is a useful biomarker for the prediction of all-cause mortality in critically ill patients: a systematic review and meta-analysis. Crit Care Med. 2014;42(9):2118–2125. doi: 10.1097/CCM.0000000000000405.
    1. Gao F, Huang XL, Cai MX, Lin MT, Wang BF, Wu W, et al. Prognostic value of serum lactate kinetics in critically ill patients with cirrhosis and acute-on-chronic liver failure: a multicenter study. Aging (Albany NY) 2019;11(13):4446–4462. doi: 10.18632/aging.102062.
    1. Johnson AE, Pollard TJ, Shen L, Lehman LW, Feng M, Ghassemi M, et al. MIMIC-III, a freely accessible critical care database. Sci Data. 2016;3:160035. doi: 10.1038/sdata.2016.35.
    1. Zhou XD, Chen QF, Zhang MC, Van Poucke S, Liu WY, Lu Y, et al. Scoring model to predict outcome in critically ill cirrhotic patients with acute respiratory failure: comparison with MELD scoring models and CLIF-SOFA score. Expert Rev Gastroenterol Hepatol. 2017;11(9):857–864. doi: 10.1080/17474124.2017.1338948.
    1. Lee NY, Suk KT. The role of the gut microbiome in liver cirrhosis treatment. Int J Mol Sci. 2020;22(1):199. doi: 10.3390/ijms22010199.
    1. .
    1. Moreau R, Jalan R, Gines P, Pavesi M, Angeli P, Cordoba J, et al. Acute-on-chronic liver failure is a distinct syndrome that develops in patients with acute decompensation of cirrhosis. Gastroenterology. 2013;144(7):1426–1437. doi: 10.1053/j.gastro.2013.02.042.
    1. Boone MD, Celi LA, Ho BG, Pencina M, Curry MP, Lior Y, et al. Model for end-stage liver disease score predicts mortality in critically ill cirrhotic patients. J Crit Care. 2014;29(5):881.e7–13. doi: 10.1016/j.jcrc.2014.05.013.
    1. Kok B, Abraldes JG. Child-pugh classification: time to abandon? Semin Liver Dis. 2019;39(1):96–103. doi: 10.1055/s-0038-1676805.
    1. Allegretti AS, Solà E, Ginès P. Clinical application of kidney biomarkers in cirrhosis. Am J Kidney Dis. 2020;76(5):710–719. doi: 10.1053/j.ajkd.2020.03.016.
    1. Dunn W, Jamil LH, Brown LS, Wiesner RH, Kim WR, Menon KV, et al. MELD accurately predicts mortality in patients with alcoholic hepatitis. Hepatology. 2005;41(2):353–358. doi: 10.1002/hep.20503.
    1. Cheng CY, Kung CT, Wu KH, Chen FC, Cheng HH, Cheng FJ, et al. Liver cirrhosis affects serum lactate level measurement while assessing disease severity in patients with sepsis. Eur J Gastroenterol Hepatol. 2021;33(9):1201–1208. doi: 10.1097/MEG.0000000000001826.
    1. Kim S, Zerillo J, Tabrizian P, Wax D, Lin HM, Evans A, et al. Postoperative meld-lactate and isolated lactate values as outcome predictors following orthotopic liver transplantation. Shock. 2017;48(1):36–42. doi: 10.1097/SHK.0000000000000835.
    1. Warren A, Soulsby CR, Puxty A, Campbell J, Shaw M, Quasim T, et al. Long-term outcome of patients with liver cirrhosis admitted to a general intensive care unit. Ann Intensive Care. 2017;7(1):37. doi: 10.1186/s13613-017-0257-6.
    1. Perilli V, Aceto P, Sacco T, Ciocchetti P, Papanice D, Lai C, et al. Usefulness of postreperfusion lactate clearance for predicting early graft recovery in liver transplant patients: a single center study. Minerva Anestesiol. 2018;84(10):1142–1149. doi: 10.23736/S0375-9393.18.12285-1.
    1. Masyuk M, Wernly B, Lichtenauer M, Franz M, Kabisch B, Muessig JM, et al. Prognostic relevance of serum lactate kinetics in critically ill patients. Intensive Care Med. 2019;45(1):55–61. doi: 10.1007/s00134-018-5475-3.

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