Model for end-stage liver disease (MELD) score as a predictor and monitor of mortality in patients with Vibrio vulnificus necrotizing skin and soft tissue infections.
BACKGROUND:Vibrio vulnificus necrotizing skin and soft tissue infections (VNSSTIs) usually predispose patients with or without preexisting liver disease to septic shock, and then evolve to multiple organ dysfunction syndrome (MODS), thus resulting in high mortality in humans. However, clinicians do...
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ftdoajarticles:oai:doaj.org/article:012ed817ee8a441ea5cbfc6fbd0ffb13 2023-05-15T15:14:40+02:00 Model for end-stage liver disease (MELD) score as a predictor and monitor of mortality in patients with Vibrio vulnificus necrotizing skin and soft tissue infections. Kuo-Chin Huang Yao-Hung Tsai Kuo-Chung Huang Mel S Lee 2015-04-01T00:00:00Z https://doi.org/10.1371/journal.pntd.0003720 https://doaj.org/article/012ed817ee8a441ea5cbfc6fbd0ffb13 EN eng Public Library of Science (PLoS) http://europepmc.org/articles/PMC4414517?pdf=render https://doaj.org/toc/1935-2727 https://doaj.org/toc/1935-2735 1935-2727 1935-2735 doi:10.1371/journal.pntd.0003720 https://doaj.org/article/012ed817ee8a441ea5cbfc6fbd0ffb13 PLoS Neglected Tropical Diseases, Vol 9, Iss 4, p e0003720 (2015) Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 article 2015 ftdoajarticles https://doi.org/10.1371/journal.pntd.0003720 2022-12-31T16:28:27Z BACKGROUND:Vibrio vulnificus necrotizing skin and soft tissue infections (VNSSTIs) usually predispose patients with or without preexisting liver disease to septic shock, and then evolve to multiple organ dysfunction syndrome (MODS), thus resulting in high mortality in humans. However, clinicians do not have a valid prediction model to provide a reliable estimate of case-fatality rate when caring for these acutely and/or critically ill patients. METHODS/PRINCIPAL FINDINGS:We retrospectively analyzed 39 consecutive patients with VNSSTIs (mean age: 65.7 ± 11.3 years) at our institution between 2007 and 2010. All patients were treated with the same protocol. Demographic and clinical characteristics, disease severity on admission, treatment details, and outcomes were collected for each patient and extracted for analyses. We studied the predictive value of the model for end-stage liver disease (MELD), modified MELD including sodium (MELD-Na), and laboratory risk indicator for necrotizing fasciitis (LRINEC) scores for case-fatality. Logistic regression and receiver operating characteristic (ROC) curve analyses were performed. The mean MELD, MELD-Na and LRINEC scores on admission were 15.1 ± 1.1, 17.7 ± 1.1, and 3.4 ± 0.4 points, respectively. After admission, these patients had temporary or progressive deterioration of nearly all their scores and lab values. The area under the ROC curve for the MELD and ΔMELD scoring models were 0.929 (p = 0.002) and 0.897 (p = 0.005), respectively. An optimal MELD/ΔMELD cutoff value ≥ 20/2 had a good sensitivity and specificity (all > 80%), with a 64/13-fold increased odds for case-fatality. Additionally, the development of severe forms of anemia (p = 0.014) and hypoalbuminemia (p = 0.019) were associated with an increased case-fatality rate. DISCUSSION:The MELD/ΔMELD scoring model is an effective risk stratification indicator at the time of admission and also an excellent condition monitor during hospitalization for medical care of acutely and/or critically ill patients with ... Article in Journal/Newspaper Arctic Directory of Open Access Journals: DOAJ Articles Arctic PLOS Neglected Tropical Diseases 9 4 e0003720 |
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Directory of Open Access Journals: DOAJ Articles |
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ftdoajarticles |
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English |
topic |
Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 |
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Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 Kuo-Chin Huang Yao-Hung Tsai Kuo-Chung Huang Mel S Lee Model for end-stage liver disease (MELD) score as a predictor and monitor of mortality in patients with Vibrio vulnificus necrotizing skin and soft tissue infections. |
topic_facet |
Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 |
description |
BACKGROUND:Vibrio vulnificus necrotizing skin and soft tissue infections (VNSSTIs) usually predispose patients with or without preexisting liver disease to septic shock, and then evolve to multiple organ dysfunction syndrome (MODS), thus resulting in high mortality in humans. However, clinicians do not have a valid prediction model to provide a reliable estimate of case-fatality rate when caring for these acutely and/or critically ill patients. METHODS/PRINCIPAL FINDINGS:We retrospectively analyzed 39 consecutive patients with VNSSTIs (mean age: 65.7 ± 11.3 years) at our institution between 2007 and 2010. All patients were treated with the same protocol. Demographic and clinical characteristics, disease severity on admission, treatment details, and outcomes were collected for each patient and extracted for analyses. We studied the predictive value of the model for end-stage liver disease (MELD), modified MELD including sodium (MELD-Na), and laboratory risk indicator for necrotizing fasciitis (LRINEC) scores for case-fatality. Logistic regression and receiver operating characteristic (ROC) curve analyses were performed. The mean MELD, MELD-Na and LRINEC scores on admission were 15.1 ± 1.1, 17.7 ± 1.1, and 3.4 ± 0.4 points, respectively. After admission, these patients had temporary or progressive deterioration of nearly all their scores and lab values. The area under the ROC curve for the MELD and ΔMELD scoring models were 0.929 (p = 0.002) and 0.897 (p = 0.005), respectively. An optimal MELD/ΔMELD cutoff value ≥ 20/2 had a good sensitivity and specificity (all > 80%), with a 64/13-fold increased odds for case-fatality. Additionally, the development of severe forms of anemia (p = 0.014) and hypoalbuminemia (p = 0.019) were associated with an increased case-fatality rate. DISCUSSION:The MELD/ΔMELD scoring model is an effective risk stratification indicator at the time of admission and also an excellent condition monitor during hospitalization for medical care of acutely and/or critically ill patients with ... |
format |
Article in Journal/Newspaper |
author |
Kuo-Chin Huang Yao-Hung Tsai Kuo-Chung Huang Mel S Lee |
author_facet |
Kuo-Chin Huang Yao-Hung Tsai Kuo-Chung Huang Mel S Lee |
author_sort |
Kuo-Chin Huang |
title |
Model for end-stage liver disease (MELD) score as a predictor and monitor of mortality in patients with Vibrio vulnificus necrotizing skin and soft tissue infections. |
title_short |
Model for end-stage liver disease (MELD) score as a predictor and monitor of mortality in patients with Vibrio vulnificus necrotizing skin and soft tissue infections. |
title_full |
Model for end-stage liver disease (MELD) score as a predictor and monitor of mortality in patients with Vibrio vulnificus necrotizing skin and soft tissue infections. |
title_fullStr |
Model for end-stage liver disease (MELD) score as a predictor and monitor of mortality in patients with Vibrio vulnificus necrotizing skin and soft tissue infections. |
title_full_unstemmed |
Model for end-stage liver disease (MELD) score as a predictor and monitor of mortality in patients with Vibrio vulnificus necrotizing skin and soft tissue infections. |
title_sort |
model for end-stage liver disease (meld) score as a predictor and monitor of mortality in patients with vibrio vulnificus necrotizing skin and soft tissue infections. |
publisher |
Public Library of Science (PLoS) |
publishDate |
2015 |
url |
https://doi.org/10.1371/journal.pntd.0003720 https://doaj.org/article/012ed817ee8a441ea5cbfc6fbd0ffb13 |
geographic |
Arctic |
geographic_facet |
Arctic |
genre |
Arctic |
genre_facet |
Arctic |
op_source |
PLoS Neglected Tropical Diseases, Vol 9, Iss 4, p e0003720 (2015) |
op_relation |
http://europepmc.org/articles/PMC4414517?pdf=render https://doaj.org/toc/1935-2727 https://doaj.org/toc/1935-2735 1935-2727 1935-2735 doi:10.1371/journal.pntd.0003720 https://doaj.org/article/012ed817ee8a441ea5cbfc6fbd0ffb13 |
op_doi |
https://doi.org/10.1371/journal.pntd.0003720 |
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PLOS Neglected Tropical Diseases |
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9 |
container_issue |
4 |
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e0003720 |
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