Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Aug 1;67(8):871-877.
doi: 10.1097/MAT.0000000000001321.

MELD Score Predicts Outcomes in Patients Undergoing Venovenous Extracorporeal Membrane Oxygenation

Satoshi Watanabe  1 , Chitaru Kurihara  2 , Adwaiy Manerikar  1 , Sanket Thakkar  2 , Mark Saine  2 , Ankit Bharat  1   2
Affiliations

MELD Score Predicts Outcomes in Patients Undergoing Venovenous Extracorporeal Membrane Oxygenation

Satoshi Watanabe et al. ASAIO J. .

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.

PubMed Disclaimer

Conflict of interest statement

Disclosure: The authors have no conflicts of interest to report.

Figures

Figure 1.
Figure 1.
Survival of Patients Undergoing VV ECMO with MELD score ≥12 and with MELD score <12
Figure 2.
Figure 2.
Receiver operating characteristic curve of MELD score
Figure 3.
Figure 3.
Receiver operating characteristic curve of RESP score
See this image and copyright information in PMC

References

    1. Agerstrand CL, Bacchetta MD, Brodie D: ECMO for adult respiratory failure: current use and evolving applications. Asaio j 60 (3): 255–62, 2014. doi: 10.1097/mat.0000000000000062. - DOI - PubMed
    1. Lehr CJ, Zaas DW, Cheifetz IM, Turner DA: Ambulatory extracorporeal membrane oxygenation as a bridge to lung transplantation: walking while waiting. Chest 147 (5): 1213–1218, 2015. doi: 10.1378/chest.14-2188. - DOI - PubMed
    1. Peek GJ, Mugford M, Tiruvoipati R, et al.: Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial. Lancet 374 (9698): 1351–63, 2009. doi: 10.1016/S0140-6736(09)61069-2. - DOI - PubMed
    1. Huang L, Zhang W, Yang Y, et al.: Application of extracorporeal membrane oxygenation in patients with severe acute respiratory distress syndrome induced by avian influenza A (H7N9) viral pneumonia: national data from the Chinese multicentre collaboration. BMC Infect Dis 18 (1): 23, 2018. doi: 10.1186/s12879-017-2903-x. - DOI - PMC - PubMed
    1. Li X, Guo Z, Li B, et al.: Extracorporeal Membrane Oxygenation for Coronavirus Disease 2019 in Shanghai, China. Asaio j, 2020. doi: 10.1097/mat.0000000000001172. - DOI - PMC - PubMed

Publication types

MeSH terms