The Model for End-Stage Liver Disease-Sodium Score at Admission Is Prognostic of Covid-19 Disease Severity
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COVID-19
The Model for End-Stage Liver Disease-Sodium Score at Admission Is Prognostic of Covid-19 Disease Severity Jason Wagner 1 & Victor Garcia-Rodriguez 1 & Abraham Yu 1 & Barbara Dutra 1 & Asmeen Bhatt 2 & Scott Larson 2 & Ahmad Farooq 2,3 Accepted: 17 September 2020 # Springer Nature Switzerland AG 2020
Abstract Covid-19 is a systemic viral respiratory illness that can cause gastrointestinal manifestations. There is evidence that Covid-19 can infect liver tissue and may cause transaminemia. A prognostic model is needed to aid clinicians in determining disease severity. The Model for End-Stage Liver Disease-Sodium (MELD-Na) score is a mortality assessment tool in liver transplant patients that has been found to be prognostic in other clinical situations. This study aimed to determine if the MELD-Na score was associated with disease severity in patients with Covid-19, as assessed by multiple clinical outcomes including death within 30 days of discharge and development of an acute kidney injury (AKI). This is a retrospective cohort study that analyzed patients admitted to a community academic hospital with the diagnosis of Covid-19. The 30-day MELD-Na score was found to be significantly higher in those who died (14.38 ± 6.92) relative to those who survived (9.68 ± 5.69; p = 0.03). Additionally, patients with a MELD-Na score greater than 10 were found to have higher risk of developing an AKI (odds ratio (OR) 3.31 (1.08, 10.17); p = 0.03), need for hemodialysis (OR 9.69 (1.74, 53.96); p = 0.007), require vasopressors (OR 4.55 (1.22, 16.99); p = 0.02), and have a longer hospital stay (OR 4.17 (1.05, 16.47); p = 0.03). The MELD-Na score may serve as a useful clinical scoring system for prognosis in patients admitted to the hospital with Covid-19. Keywords Covid-19 . MELD-Na score . Prognostic factor . Acute kidney injury
Introduction Covid-19 is a predominantly respiratory illness that can cause systemic symptoms. Prognostic modeling systems are needed to aid clinicians in risk assessment for patients admitted to the hospital with Covid-19. Many have been proposed, however, a recent systematic review has found that few models are reliable [1]. The Model for End Stage Liver Disease-Sodium This article is part of the Topical Collection on Covid-19 * Ahmad Farooq [email protected] 1
Department of Internal Medicine, University of Texas Health Science Center at Houston, 6431 Fannin, MSB 1.150, Houston, TX 77030, USA
2
Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Texas Health Science Center at Houston, 6431 Fannin, MSB 1.150, Houston, TX 77030, USA
3
Department of Internal Medicine, Division of Gastroenterology and Hepatology, Duke University, Durham, NC, USA
or MELD-Na score is a scoring system that predicts 90-day mortality for patients awaiting liver transplant [2, 3]. The model has proven to be very useful given its reliance on easily obtained and objective laboratory data. Recently, a study found that the MELD-Na score could accurately predict mortality
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