title: Association of Model for End-Stage Liver Disease Score and Mortality in Trauma Patients With Chronic Liver Disease.
abstract: OBJECTIVE
  The Model for End-Stage Liver Disease (MELD) score is predictive of trauma outcomes.
  
  
  OBJECTIVE
  To determine whether a decrease in MELD score is associated with improved mortality in critically ill trauma patients.
  
  
  METHODS
  We performed a retrospective registry study of critically ill trauma patients 18 years or older with chronic liver disease treated between August 3, 1998, and January 5, 2012, at 2 level I trauma centers in Boston, Massachusetts. The consecutive sample included 525 patients (male, 373 [71.0%]; white, 399 [76.0%]; mean [SD] age, 55.0 [12.4] years).
  
  
  METHODS
  Change in MELD score from intensive care unit (ICU) admission to 48 to 72 hours later.
  
  
  METHODS
  Thirty-day all-cause mortality.
  
  
  RESULTS
  The mean (SD) MELD score at ICU admission was 19.3 (9.7). The 30-day mortality was 21.9%. The odds of 30-day mortality with a change in MELD score of less than -2, -2 to -1, +1 to +4, and greater than +4 were 0.23 (95% CI, 0.10-0.51), 0.30 (95% CI, 0.10-0.85), 0.57 (95% CI, 0.27-1.20), and 1.31 (95% CI, 0.58-2.96), respectively, relative to a change in MELD score of 0 and adjusted for age, sex, race, Charlson/Deyo Index, sepsis, number of acute organ failures, International Classification of Diseases, Ninth Revision-based injury severity score, and ICU admission MELD score.
  
  
  CONCLUSIONS
  A decrease in MELD score within 72 hours of ICU admission is associated with improved mortality.
authors.affiliation: Division of Trauma, Burns, and Surgical Critical Care, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Allan
authors.initials: A
authors.lastname: Peetz
authors.affiliation: Division of Trauma, Burns, and Surgical Critical Care, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Ali
authors.initials: A
authors.lastname: Salim
authors.affiliation: Division of Trauma, Burns, and Surgical Critical Care, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Reza
authors.initials: R
authors.lastname: Askari
authors.affiliation: Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston.
authors.forename: Marc A
authors.initials: MA
authors.lastname: De Moya
authors.affiliation: Division of Trauma, Burns, and Surgical Critical Care, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Olubode A
authors.initials: OA
authors.lastname: Olufajo
authors.affiliation: Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Tracey G
authors.initials: TG
authors.lastname: Simon
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston.
authors.forename: Fiona K
authors.initials: FK
authors.lastname: Gibbons
authors.affiliation: The Nathan E. Hellman Memorial Laboratory, Renal Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Kenneth B
authors.initials: KB
authors.lastname: Christopher
mesh_terms: D001900:Boston / Q000453:epidemiology; D016638:Critical Illness; D058625:End Stage Liver Disease / Q000401:mortality*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014193:Trauma Centers; D014947:Wounds and Injuries / Q000401:mortality*