MELD Score Predicts Outcomes in Patients Undergoing Venovenous Extracorporeal Membrane Oxygenation

Satoshi Watanabe; Chitaru Kurihara; Adwaiy Manerikar; Sanket Thakkar; Mark Saine; Ankit Bharat

doi:10.1097/MAT.0000000000001321

MELD Score Predicts Outcomes in Patients Undergoing Venovenous Extracorporeal Membrane Oxygenation

Satoshi Watanabe, Chitaru Kurihara, Adwaiy Manerikar, Sanket Thakkar, Mark Saine, Ankit Bharat^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

2 Scopus citations

Abstract

Venovenous extracorporeal membrane oxygenation (VV ECMO) is increasingly being used in the management of severe acute respiratory distress syndrome (ARDS). The Respiratory ECMO Survival Prediction (RESP) score is most commonly used to predict survival of patients undergoing ECMO. However, the RESP score does not incorporate renal and hepatic dysfunction which are frequently a part of the constellation of multiorgan dysfunction associated with ARDS. The Model for End-Stage Liver Disease (MELD) incorporates both liver and kidney dysfunction and is used in the risk stratification of liver transplant recipients as well as those undergoing cardiac surgery. The aim of this study was to assess the prognostic value of the MELD score in patients undergoing VV ECMO. Patients undergoing VV ECMO from 2016 to 2019 were extracted from our prospectively maintained institutional ECMO database and stratified based on MELD score. Baseline clinical, laboratory, and follow-up data, as well as post-ECMO outcomes, were compared. Of 71 patients, 50 patients (70.4%) had a MELD score <12 and 21 (29.6%) had a MELD score ≥12. The higher MELD score was associated with increased post-ECMO mortality but reduced risk of dialysis and tracheostomy. In multivariate analysis, higher MELD score (HR 1.35, 95% CI = 1.07-2.75), lower body surface area (HR 0.16, 0.04-0.65), RESP score (HR 0.75, 95% CI = 0.64-0.87), and platelet count (HR 0.99, 95% CI = 0.98-0.99), were significant predictors of postoperative mortality. We conclude that MELD score can be used complementarily to the RESP score to predict outcomes in patients with ARDS undergoing VV ECMO.

Original language	English (US)
Pages (from-to)	871-877
Number of pages	7
Journal	ASAIO Journal
Volume	67
Issue number	8
DOIs	https://doi.org/10.1097/MAT.0000000000001321
State	Published - Aug 1 2021

Funding

From the *Department of Medicine and †Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois Submitted for consideration May 2020; accepted for publication in revised form September 2020. Disclosure: The authors have no conflicts of interest to report. This work was supported by the National Institutes of Health, NIH HL145478, HL147290, and HL147575 (to AB). Satoshi Watanabe and Chitaru Kurihara contributed equally to this work. Correspondence: Ankit Bharat, MD, FACS, Department of Surgery, Northwestern University Feinberg School of Medicine, Division of Thoracic Surgery, 676 N. St. Clair Street, Suite 650, Chicago, Illinois 60611. Email: [email protected]; Twitter: @ankitbharatmd. Copyright © ASAIO 2020

Keywords

MELD score
acute respiratory distress syndrome
anticoagulation
extracorporeal membrane oxygenation

ASJC Scopus subject areas

Biophysics
Bioengineering
Biomaterials
Biomedical Engineering

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10.1097/MAT.0000000000001321

Cite this

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title = "MELD Score Predicts Outcomes in Patients Undergoing Venovenous Extracorporeal Membrane Oxygenation",

abstract = "Venovenous extracorporeal membrane oxygenation (VV ECMO) is increasingly being used in the management of severe acute respiratory distress syndrome (ARDS). The Respiratory ECMO Survival Prediction (RESP) score is most commonly used to predict survival of patients undergoing ECMO. However, the RESP score does not incorporate renal and hepatic dysfunction which are frequently a part of the constellation of multiorgan dysfunction associated with ARDS. The Model for End-Stage Liver Disease (MELD) incorporates both liver and kidney dysfunction and is used in the risk stratification of liver transplant recipients as well as those undergoing cardiac surgery. The aim of this study was to assess the prognostic value of the MELD score in patients undergoing VV ECMO. Patients undergoing VV ECMO from 2016 to 2019 were extracted from our prospectively maintained institutional ECMO database and stratified based on MELD score. Baseline clinical, laboratory, and follow-up data, as well as post-ECMO outcomes, were compared. Of 71 patients, 50 patients (70.4%) had a MELD score <12 and 21 (29.6%) had a MELD score ≥12. The higher MELD score was associated with increased post-ECMO mortality but reduced risk of dialysis and tracheostomy. In multivariate analysis, higher MELD score (HR 1.35, 95% CI = 1.07-2.75), lower body surface area (HR 0.16, 0.04-0.65), RESP score (HR 0.75, 95% CI = 0.64-0.87), and platelet count (HR 0.99, 95% CI = 0.98-0.99), were significant predictors of postoperative mortality. We conclude that MELD score can be used complementarily to the RESP score to predict outcomes in patients with ARDS undergoing VV ECMO.",

keywords = "MELD score, acute respiratory distress syndrome, anticoagulation, extracorporeal membrane oxygenation",

author = "Satoshi Watanabe and Chitaru Kurihara and Adwaiy Manerikar and Sanket Thakkar and Mark Saine and Ankit Bharat",

note = "Funding Information: From the *Department of Medicine and †Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois Submitted for consideration May 2020; accepted for publication in revised form September 2020. Disclosure: The authors have no conflicts of interest to report. This work was supported by the National Institutes of Health, NIH HL145478, HL147290, and HL147575 (to AB). Satoshi Watanabe and Chitaru Kurihara contributed equally to this work. Correspondence: Ankit Bharat, MD, FACS, Department of Surgery, Northwestern University Feinberg School of Medicine, Division of Thoracic Surgery, 676 N. St. Clair Street, Suite 650, Chicago, Illinois 60611. Email: [email protected]; Twitter: @ankitbharatmd. Copyright {\textcopyright} ASAIO 2020 Publisher Copyright: Copyright {\textcopyright} ASAIO 2020.",

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doi = "10.1097/MAT.0000000000001321",

language = "English (US)",

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T1 - MELD Score Predicts Outcomes in Patients Undergoing Venovenous Extracorporeal Membrane Oxygenation

AU - Watanabe, Satoshi

AU - Kurihara, Chitaru

AU - Manerikar, Adwaiy

AU - Thakkar, Sanket

AU - Saine, Mark

AU - Bharat, Ankit

N1 - Funding Information: From the *Department of Medicine and †Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois Submitted for consideration May 2020; accepted for publication in revised form September 2020. Disclosure: The authors have no conflicts of interest to report. This work was supported by the National Institutes of Health, NIH HL145478, HL147290, and HL147575 (to AB). Satoshi Watanabe and Chitaru Kurihara contributed equally to this work. Correspondence: Ankit Bharat, MD, FACS, Department of Surgery, Northwestern University Feinberg School of Medicine, Division of Thoracic Surgery, 676 N. St. Clair Street, Suite 650, Chicago, Illinois 60611. Email: [email protected]; Twitter: @ankitbharatmd. Copyright © ASAIO 2020 Publisher Copyright: Copyright © ASAIO 2020.

PY - 2021/8/1

Y1 - 2021/8/1

N2 - Venovenous extracorporeal membrane oxygenation (VV ECMO) is increasingly being used in the management of severe acute respiratory distress syndrome (ARDS). The Respiratory ECMO Survival Prediction (RESP) score is most commonly used to predict survival of patients undergoing ECMO. However, the RESP score does not incorporate renal and hepatic dysfunction which are frequently a part of the constellation of multiorgan dysfunction associated with ARDS. The Model for End-Stage Liver Disease (MELD) incorporates both liver and kidney dysfunction and is used in the risk stratification of liver transplant recipients as well as those undergoing cardiac surgery. The aim of this study was to assess the prognostic value of the MELD score in patients undergoing VV ECMO. Patients undergoing VV ECMO from 2016 to 2019 were extracted from our prospectively maintained institutional ECMO database and stratified based on MELD score. Baseline clinical, laboratory, and follow-up data, as well as post-ECMO outcomes, were compared. Of 71 patients, 50 patients (70.4%) had a MELD score <12 and 21 (29.6%) had a MELD score ≥12. The higher MELD score was associated with increased post-ECMO mortality but reduced risk of dialysis and tracheostomy. In multivariate analysis, higher MELD score (HR 1.35, 95% CI = 1.07-2.75), lower body surface area (HR 0.16, 0.04-0.65), RESP score (HR 0.75, 95% CI = 0.64-0.87), and platelet count (HR 0.99, 95% CI = 0.98-0.99), were significant predictors of postoperative mortality. We conclude that MELD score can be used complementarily to the RESP score to predict outcomes in patients with ARDS undergoing VV ECMO.

AB - Venovenous extracorporeal membrane oxygenation (VV ECMO) is increasingly being used in the management of severe acute respiratory distress syndrome (ARDS). The Respiratory ECMO Survival Prediction (RESP) score is most commonly used to predict survival of patients undergoing ECMO. However, the RESP score does not incorporate renal and hepatic dysfunction which are frequently a part of the constellation of multiorgan dysfunction associated with ARDS. The Model for End-Stage Liver Disease (MELD) incorporates both liver and kidney dysfunction and is used in the risk stratification of liver transplant recipients as well as those undergoing cardiac surgery. The aim of this study was to assess the prognostic value of the MELD score in patients undergoing VV ECMO. Patients undergoing VV ECMO from 2016 to 2019 were extracted from our prospectively maintained institutional ECMO database and stratified based on MELD score. Baseline clinical, laboratory, and follow-up data, as well as post-ECMO outcomes, were compared. Of 71 patients, 50 patients (70.4%) had a MELD score <12 and 21 (29.6%) had a MELD score ≥12. The higher MELD score was associated with increased post-ECMO mortality but reduced risk of dialysis and tracheostomy. In multivariate analysis, higher MELD score (HR 1.35, 95% CI = 1.07-2.75), lower body surface area (HR 0.16, 0.04-0.65), RESP score (HR 0.75, 95% CI = 0.64-0.87), and platelet count (HR 0.99, 95% CI = 0.98-0.99), were significant predictors of postoperative mortality. We conclude that MELD score can be used complementarily to the RESP score to predict outcomes in patients with ARDS undergoing VV ECMO.

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KW - acute respiratory distress syndrome

KW - anticoagulation

KW - extracorporeal membrane oxygenation

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MELD Score Predicts Outcomes in Patients Undergoing Venovenous Extracorporeal Membrane Oxygenation

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