Open AccessThe Model for End-stage Liver Disease (MELD) as a predictor of short-term mortality in Staphylococcus aureus bloodstream infection: A single-centre observational study
Author(s) -
Jan A Roth,
Andréas Widmer,
Sarah TschudinSutter,
Marc Dangel,
Reno Frei,
Manuel Battegay,
Balthasar L. Hug
Publication year - 2017
Publication title -
plos one
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.99
H-Index - 332
ISSN - 1932-6203
DOI - 10.1371/journal.pone.0175669
Subject(s) - medicine , confidence interval , odds ratio , observational study , logistic regression , staphylococcus aureus , population , liver disease , prospective cohort study , staphylococcal infections , mortality rate , biology , genetics , environmental health , bacteria
Background Automated laboratory-based prediction models may support clinical decisions in Staphylococcus aureus bloodstream infections (BSIs), which carry a particularly high mortality. Small studies indicated that the laboratory-based Model for End-stage Liver Disease (MELD) score is a risk factor for mortality in critically ill patients with infections. For S . aureus BSIs, we therefore aimed to assess a potential association of the MELD score with mortality. Methods In this single-centre observational study, all consecutive patients with a first episode of methicillin-susceptible S . aureus BSI occurring between 2001 and 2013 were eligible. Relevant patient data were retrieved from our prospective in-house BSI database. We assessed the association of the MELD score at day of BSI onset (range ± two days) with 30-day all-cause mortality using uni- and multivariable logistic regression analysis. Results 561 patients were included in the final analysis. The MELD score at BSI onset was associated with 30-day mortality in S . aureus BSIs (odds ratio per 1-point increase, 1.06; 95% confidence interval, 1.03‒1.09; P < 0.001). After adjustment for relevant patient and infection characteristics, an increased MELD score remained a predictor of 30-day mortality (adjusted odds ratio per 1-point increase, 1.05; 95% confidence interval, 1.01‒1.08; P = 0.005). Conclusions In our study population, the MELD score at BSI onset was an independent predictor of mortality in S . aureus BSIs. We therefore suggest to prospectively validate the MELD score as part of clinical decision support systems in inpatients with suspected or confirmed BSI.