The Model for End-Stage Liver Disease-Sodium Score at Admission Is Prognostic of Covid-19 Disease Severity

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.

Platelet-albumin-bilirubin score and neutrophil-to-lymphocyte ratio predict intensive care unit admission in patients with end-stage kidney disease infected with the Omicron variant of COVID-19: a single-center prospective cohort study

“…Wagner et al. suggested that hypoalbuminemia and elevated transaminases in COVID-19 are predictors of disease severity, and proposed the MELD-na score to assess the severity of COVID-19 patients [ 24 , 25 ]. Zou et al.…”

MELD-Na score, Acute Physiologic and Chronic Health Evaluation II score, and SOFA score and their association with mortality in critically ill COVID-19 patients with liver injury: A retrospective single-center study

“…[ 33 ] We are aware of only one study on MELD-Na score and its association with increased mortality in COVID-19 which was performed on 107 hospitalized COVID-19 patients and did not adjust for confounding variables or specifically investigate critically ill COVID-19 patients with liver injury. [ 8 ] Our study included a larger sample size and focused on critically ill COVID-19 patients with acute liver injury. The mean MELD-Na score for our sample was approximately 14 points which represents the lowest mortality range.…”

“…[ 6 ] The Model for End-Stage Liver Disease modified for Sodium concentration (MELD-Na) score is a prognostic tool for patients awaiting liver transplant that is also commonly applied to estimate mortality in acute liver failure patients. [ 7 ] A study among general COVID-19 patients found that the MELD-Na score predicted mortality from renal failure;[ 8 ] however, literature on MELD-Na predicting mortality for liver injury in COVID-19 patients is lacking.…”