Reyes-Ruiz José Manuel, Avelino-Santiago Ana Citlali, Martínez-Mier Gustavo, López-López Claudia Vanessa, De Jesús-González Luis Adrián, León-Juárez Moises, Osuna-Ramos Juan Fidel, Farfan-Morales Carlos Noe, Palacios-Rápalo Selvin Noé, Bernal-Dolores Víctor, Del Ángel Rosa María
Unidad Médica de Alta Especialidad, Hospital de Especialidades No. 14, Centro Médico Nacional "Adolfo Ruiz Cortines", Instituto Mexicano del Seguro Social (IMSS), Veracruz 91897, Mexico.
Facultad de Medicina, Complejo Regional Sur Tehuacán, Benemérita Universidad Autónoma de Puebla (BUAP), Puebla 7585, Mexico.
J Clin Med. 2024 Sep 27;13(19):5777. doi: 10.3390/jcm13195777.
: Coronavirus Disease 2019 (COVID-19) can cause liver injury and a deterioration of hepatic function. The Model for End-Stage Liver Disease (MELD) score is a good predictor for poor prognosis of hospitalized COVID-19 patients in the United States, Egypt and Turkey. Nevertheless, the best cut-off value for the MELD score to predict mortality in the Mexican population has yet to be established. : A total of 234 patients with COVID-19 were studied in a tertiary-level hospital. Patients were stratified into survivors ( = 139) and non-survivors ( = 95). Receiver operating characteristic curves, Cox proportional hazard models, Kaplan-Meier method, and Bonferroni corrections were performed to identify the predictors of COVID-19 mortality. : MELD score had an area under the curve of 0.62 (95% CI: 0.56-0.68; = 0.0009), sensitivity = 53.68%, and specificity = 73.38%. Univariate Cox proportional hazard regression analysis suggested that the leukocytes > 10.6, neutrophils > 8.42, neutrophil-to-lymphocyte ratio (NLR) > 8.69, systemic immune-inflammation index (SII) > 1809.21, MELD score > 9, and leukocyte glucose index (LGI) > 2.41 were predictors for mortality. However, the multivariate Cox proportional hazard model revealed that only the MELD score >9 (Hazard Ratio [HR] = 1.83; 95% confidence interval [CI]: 1.2-2.8; = 0.03) was an independent predictor for mortality of COVID-19. : Although the MELD score is used for liver transplantation, we suggest that a MELD score >9 could be an accurate predictor for COVID-19 mortality at admission to ICU requiring mechanical ventilation.
2019冠状病毒病（COVID-19）可导致肝损伤及肝功能恶化。终末期肝病模型（MELD）评分是美国、埃及和土耳其住院COVID-19患者预后不良的良好预测指标。然而，MELD评分预测墨西哥人群死亡率的最佳临界值尚未确定。：在一家三级医院对234例COVID-19患者进行了研究。患者被分为幸存者（n = 139）和非幸存者（n = 95）。采用受试者工作特征曲线、Cox比例风险模型、Kaplan-Meier法和Bonferroni校正来确定COVID-19死亡率的预测因素。：MELD评分的曲线下面积为0.62（95%CI：0.56-0.68；P = 0.0009），敏感性 = 53.68%，特异性 = 73.38%。单因素Cox比例风险回归分析表明，白细胞>10.6、中性粒细胞>8.42、中性粒细胞与淋巴细胞比值（NLR）>8.69、全身免疫炎症指数（SII）>1809.21、MELD评分>9和白细胞葡萄糖指数（LGI）>2.41是死亡率的预测因素。然而，多因素Cox比例风险模型显示，只有MELD评分>9（风险比[HR]=1.83；95%置信区间[CI]：1.2-2.8；P = 0.03）是COVID-19死亡率的独立预测因素。：尽管MELD评分用于肝移植，但我们建议MELD评分>9可能是入住需要机械通气的重症监护病房时COVID-19死亡率的准确预测指标。
