Elif KÜPELİ, Orçun ÇİFTCİ, İbrahim Haldun MÜDERRİSOĞLU, Çaşıt Olgun ÇELİK, Güldeniz UZAR

MELD-XI skoru orta-yüksek riskli pulmoner tromboemboli hastalarında basitleştirilmiş pulmoner emboli ciddiyet indeksinden bağımsız olarak hastane içi mortaliteyi öngörmektedir

Giriş: Akut pulmoner tromboemboli (PTE) yüksek oranda morbid ve fatal bir durumdur. PTE’de mortalite riskinin öngörülmesi için çeşitli risk sınıflama modelleri olsa da, henüz hiçbir çalışma PTE’de karaciğer ve böbrek fonksiyon bozukluğu gibi vital organların bozulmuş fonksiyonunun mortalite üzerine etkisine yoğunlaşmamıştır. MELD-XI (INR çıkarılmış son dönem karaciğer hastalığı modeli), son dönem karaciğer ve kardiyovasküler hastalıklarda mortaliteyi öngörmektedir. Bu çalışmada MELD-XI skorunun orta-yüksek riskli PTE hastalarında hastane içi ölümü öngörücü rolünü belirlemeyi amaçladık. Materyal ve Metod: 01.06.2011 ve 01.01.2019 tarihleri arasında orta-yüksek PTE ile yatırılan hastaların tıbbi kayıtları tarandı. Basitleştirilmiş pulmoner emboli ciddiyet indeksi (sPESI) skoru ve MELD-XI skoru hesaplandı ve hastane içi mortalite belirlendi. MELDXI skoru hastane içinde ölen ve ölmeyen hastalar arasında karşılaştırıldı ve sPESI skoru ile korele edildi. MELD-XI skorunun hastane içi ölüm içi öngördürücü değeri test edildi ve Kaplan Meier eğrisi ve log rank testi kullanılarak MELD-XI skoru için sağkalım analizi yapıldı. Bulgular: Çalışmaya toplam 104 hasta [ortalama yaş 70.8 ± 15.9 yıl; 68 (%65.4) kadın] alındı. On dört (%13.5) hasta hastanede öldü. MELD-XI ve sPESI skorları anlamlı şekilde birbirleriyle koreleydi ve ölenlerde yaşayanlara göre anlamlı şekilde daha yüksekti [17.3 (sırasıyla ÇAA 14.3)’e karşılık 10.12 (ÇAA 2.99); p< 0.05 ve 2 (ÇAA 1)’ye karşılık 1 (ÇAA 1); p< 0.05]. MELD-XI skoru ve sPESI skoru anlamlı şekilde korele idiler (r= 0.232; p< 0.05). MELD-XI skoru ve sPESI skoru çok değişkenli analizde hastane içi ölümün anlamlı öngördürücüsüydüler. MELD-XI skorunun ≥ 10.25 olması hastane içi mortaliteyi %78.6 duyarlılık ve %70.0 özgüllükle öngörebiliyordu. Sağkalım analizinde yüksek MELD-XI kategorisi (MELD-XI skoru ≥ 10.2) hastane içi sağkalımı anlamlı şekilde kötüleştirmekteydi (p< 0.01; log rank testi). Sonuç: MELD-XI skoru orta-yüksek riskli PTE hastalarında mortalitenin öngörülmesinde iyi performansı göstermektedir. Bu konunun geniş, randomize kontrollü çalışmalarla ileri araştırılması gerekir.

MELD-XI score predicts in-hospital mortality independent of simplified pulmonary embolism severity index among patients with intermediate-to-high risk acute pulmonary thromboembolism

Introduction: Acute pulmonary thromboembolism (PTE) is a highly morbidand fatal condition. Although several risk stratification models exist forprediction of mortality risk in PTE, no study has yet focused on the effect ofimpaired vital organ function, such as renal or hepatic impairment, onmortality in PTE. MELD-XI (Model for end-stage liver disease excluding INR)score predicts mortality among patients with end-stage hepatic andcardiovascular disorders. Herein, we aimed to test MELD-XI score forpredicting in-hospital prognosis of patients with intermediate-to-high riskacute PTE.Materials and Methods: We reviewed the medical records patients older than18 years hospitalized with intermediate-to-high risk PTE between 01.06.2011and 01.01.2019. Simplified pulmonary embolism severity index (sPESI) scoreand MELD-XI score were calculated, and in-hospital mortality determined.MELD-XI score was compared between patients with and without in-hospitalmortality and was correlated to sPESI score. The predictive power of MELD-XIscore for in-hospital mortality was sought and an in-hospital survival analysiswith Kaplan Meier curve and log-rank test was done for MELD-XI score.Results: A total of 104 patients [mean age of 70.8 ± 15.9 years; 68 (65.4%)females]. Fourteen (13.5%) patients died at hospital. MELD-XI and sPESIscores were significantly correlated to each other and were higher in deceased patients than the survivors [17.3 (IQR 14.3) vs. 10.12(IQR 2.99); p< 0.05 and 2 (IQR 1) vs. 1 (IQR 1); p< 0.05, respectively]. MELD-XI score and sPESI score were significant predictorof in-hospital mortality in multivariate analysis. A MELD-XI score ≥ 10.25 had a sensitivity of 78.6% and a specificity of 70.0% forin-hospital mortality. A survival analysis revealed that a high MELD-XI category (MELD-XI score ≥ 10.2) significantly worsenedin-hospital survival (p< 0.01; log rank test).Conclusion: MELD-XI score performs well for mortality prediction among patients with intermediate-to-high risk PTE. This subjectneeds to be further studied by large, randomized controlled studies.

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