title: The Model for End-Stage Liver Disease score: an independent prognostic factor of mortality in injured cirrhotic patients.
abstract: OBJECTIVE
  To examine the ability of the model for end-stage liver disease (MELD) score to predict the risk of mortality in trauma patients with cirrhosis. Although cirrhosis is associated with poor outcomes after injury, the relative effect of the severity of the cirrhosis on outcomes is unclear. The MELD score is a prospectively developed and validated scoring system, which is associated with increasing severity of hepatic dysfunction and risk of death in patients with chronic liver disease.
  
  
  METHODS
  Retrospective review. The MELD score for each patient was calculated from the international normalized ratio, the serum creatinine level, and the serum total bilirubin level obtained from the patient at admission to the level 1 trauma center. The association of MELD score with mortality was assessed using logistic regression analysis.
  
  
  METHODS
  Level 1 trauma center.
  
  
  METHODS
  Cirrhotic patients with trauma admitted to the level 1 trauma center during the period from January 2003 to December 2009.
  
  
  METHODS
  Mortality.
  
  
  RESULTS
  During the 7-year study period, 285 injured cirrhotic patients were admitted. The mean (SD) age was 50.0 (10.5) years, and the mean (SD) MELD score was 11.7 (4.8) (range, 6-28). Overall, patients who died had a significantly higher mean (SD) MELD score than did survivors (14.1 [5.4] vs 11.2 [4.6]; P < .001). The MELD score and the injury severity score were statistically significant risk factors that were independently associated with mortality in this group of patients (the area under the curve for the model was 0.944; cumulative R(2) = 0.545). Each unit increase in the MELD score was associated with an 18% increase in the odds for mortality (adjusted odds ratio, 1.18 [95% confidence interval, 1.08-1.29]; P < .001).
  
  
  CONCLUSIONS
  The MELD score is a simple objective tool for risk stratification in cirrhotic patients who have sustained injury.
authors.affiliation: Division of Trauma Surgery and Surgical Critical Care, University of Southern California, Los Angeles County Medical Center, Los Angeles, CA 90033, USA. kinaba@surgery.usc.edu
authors.forename: Kenji
authors.initials: K
authors.lastname: Inaba
authors.forename: Galinos
authors.initials: G
authors.lastname: Barmparas
authors.forename: Shelby
authors.initials: S
authors.lastname: Resnick
authors.forename: Timothy
authors.initials: T
authors.lastname: Browder
authors.forename: Linda S
authors.initials: LS
authors.lastname: Chan
authors.forename: Lydia
authors.initials: L
authors.lastname: Lam
authors.forename: Peep
authors.initials: P
authors.lastname: Talving
authors.forename: Demetrios
authors.initials: D
authors.lastname: Demetriades
mesh_terms: D000328:Adult; D001663:Bilirubin / Q000097:blood; D003404:Creatinine / Q000097:blood; D058625:End Stage Liver Disease; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008103:Liver Cirrhosis / Q000401:mortality*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D014947:Wounds and Injuries / Q000401:mortality*
chemical_list: D003404:Creatinine; D001663:Bilirubin