Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academic of Medical Sciences, Guangzhou, 510080, China.
Department of Cardiology, The Second People's Hospital of Nanhai District, Guangdong General Hospital's Nanhai Hospital, Foshan, 528251, China.
Eur J Clin Microbiol Infect Dis. 2018 Jul;37(7):1243-1250. doi: 10.1007/s10096-018-3240-8. Epub 2018 Mar 29.
The suitability of the model for end-stage liver disease excluding international normalized ratio (MELD-XI) score to predict adverse outcomes in infective endocarditis (IE) patients remains uncertain. This study was performed to explore the prognostic value of the MELD-XI score and modified MELD-XI score for patients with IE. A total of 858 patients with IE were consecutively enrolled and classified into two groups: MELD-XI ≤ 10 (n = 588) and MELD-XI > 10 (n = 270). Multivariate analysis was performed to determine risk factors independent of MELD-XI score. Higher MELD-XI score was associated with higher in-hospital mortality (15.6 vs. 4.8%, p < 0.001) and major adverse clinical events (33.3 vs. 18.4%, p < 0.001). MELD-XI score was an independent predictor of in-hospital death (odds ratio [OR] = 1.06, 95% CI, 1.02-1.10, p = 0.005). Based on a multivariate analysis, NYHA class III or IV (3 points), C-reactive protein > 9.5 mg/L (4 points), and non-surgical treatment (6 points) were added to MELD-XI score. Modified MELD-XI score produced higher predictive power than previous (AUC 0.823 vs. 0.701, p < 0.001). The cumulative incidence of long-term mortality (median 29 months) was significantly higher in patients with modified MELD-XI score > 13 than those without (log-rank = 25.30, p < 0.001). Modified MELD-XI score was independently associated with long-term mortality (hazard ratio = 1.08, 95% CI, 1.04-1.12, p < 0.001). MELD-XI score could be used as a risk assessment tool in IE. Furthermore, modified MELD-XI score remained simple and more effective in predicting poor prognosis.
MELD-XI 评分排除国际标准化比值（MELD-XI）模型预测感染性心内膜炎（IE）患者不良结局的适用性尚不确定。本研究旨在探讨 MELD-XI 评分和改良 MELD-XI 评分对 IE 患者的预后价值。共连续纳入 858 例 IE 患者，分为 MELD-XI≤10（n=588）和 MELD-XI＞10（n=270）两组。采用多因素分析确定独立于 MELD-XI 评分的危险因素。较高的 MELD-XI 评分与更高的住院死亡率（15.6% vs. 4.8%，p＜0.001）和主要不良临床事件（33.3% vs. 18.4%，p＜0.001）相关。MELD-XI 评分是住院死亡的独立预测因子（比值比[OR]＝1.06，95%CI，1.02-1.10，p＝0.005）。基于多因素分析，NYHA 心功能分级 III 或 IV 级（3 分）、C 反应蛋白＞9.5mg/L（4 分）和非手术治疗（6 分）被添加到 MELD-XI 评分中。改良 MELD-XI 评分的预测能力高于之前的评分（AUC 0.823 与 0.701，p＜0.001）。改良 MELD-XI 评分＞13 的患者长期死亡率（中位 29 个月）的累积发生率明显高于评分＜13 的患者（对数秩检验＝25.30，p＜0.001）。改良 MELD-XI 评分与长期死亡率独立相关（危险比[HR]＝1.08，95%CI，1.04-1.12，p＜0.001）。MELD-XI 评分可作为 IE 的风险评估工具。此外，改良 MELD-XI 评分仍然简单且更有效地预测预后不良。
