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Journals / Anatolian Journal of Emergency Medicine / 2026 / Cilt: 8 Sayı: 2

The Prognostic Value of MELD-XI Score in Emergency Department Patients with ST Segment Elevation Myocardial Infarction

Acil Serviste ST-Segment Yükselmeli Miyokard Enfarktüsü Geçiren Hastalarda MELD-XI Skorunun Prognostik Değeri

Şirin Ertuğrul(Emergency Medicine Service, Alaşehir State Hospital)0000-0001-5973-1973
Yalcin Golcuk(MUĞLA SITKI KOÇMAN ÜNİVERSİTESİ, TIP FAKÜLTESİ)0000-0002-8530-8607
Pages
59–65
Publication Date
2025-06-26
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AI Summary & Key Takeaways

AI Insight
⚡ TL;DR(Too Long; Didn't Read)

By incorporating liver and renal function indicators, the MELD-XI score enhances conventional risk stratification and facilitates more targeted clinical interventions.

📌 3 Key Takeaways

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Objective & Hypothesis:Aim: Effective risk stratification is essential for patients with acute ST-elevation myocardial infarction (STEMI) to enable timely and appropriate interventions.
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Key Findings & Data:Liver dysfunction has emerged as a significant predictor of poor cardiovascular outcomes.
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Conclusion & Impact:By incorporating liver and renal function indicators, the MELD-XI score enhances conventional risk stratification and facilitates more targeted clinical interventions.
🔬Design:Modeling & Simulation
📍Scope:2019 Verileri
⚙️Variables:Acil servis · MELD-XI skoru · mortalite

Abstract

Aim: Effective risk stratification is essential for patients with acute ST-elevation myocardial infarction (STEMI) to enable timely and appropriate interventions. Liver dysfunction has emerged as a significant predictor of poor cardiovascular outcomes. The Model for End-stage Liver Disease (MELD)-XI score, initially designed to assess liver disease severity, has demonstrated prognostic value in cardiovascular contexts; however, its application to STEMI patients in emergency department (ED) settings remains underexplored. Material and Methods: This retrospective study was conducted at Mugla Training and Research Hospital from July 2019 to January 2021. It included adult STEMI patients diagnosed per the European Society of Cardiology criteria. The primary outcome was 28-day allcause mortality. Statistical analyses included univariate and Cox regression for mortality predictors and Receiver Operating Characteristic and Kaplan-Meier analyses to assess the MELD-XI score's predictive accuracy. Results: Among 237 patients, 8.4% (n=20) died within 28 days. Non-survivors had significantly higher MELD-XI scores (10.72 vs. 9.44, p<0.001) and lower left ventricular ejection fractions (LVEF) (35% vs. 50%, p<0.001). A MELD-XI score threshold of 9.76 predicted mortality with 80% sensitivity and 70.5% specificity (AUC=0.813) and was negatively correlated with LVEF (r=-0.223, p<0.001). Kaplan-Meier analysis showed that patients with MELD-XI scores above 9.76 had significantly higher 28-day mortality (Log-rank test = 5.43, p<0.001). Independent predictors of mortality included MELD-XI score ≥9.76, age, cardiac arrest on admission, glucose, and hemoglobin levels. Conclusion: The MELD-XI score is a valuable prognostic tool for assessing 28-day mortality risk in STEMI patients in EDs. By incorporating liver and renal function indicators, the MELD-XI score enhances conventional risk stratification and facilitates more targeted clinical interventions.

Özet

Amaç: Akut ST-elevasyonu miyokard infarktüsü (STEMI) hastalarında etkili risk stratifikasyonu, zamanında ve uygun müdahalelerin yapılabilmesi için kritik öneme sahiptir. Karaciğer fonksiyon bozukluğu, kötü kardiyovasküler sonuçların güçlü bir prediktörü olarak öne çıkmaktadır. Başlangıçta karaciğer hastalığının şiddetini değerlendirmek amacıyla geliştirilen Model for End-stage Liver Disease (MELD)-XI skoru, kardiyovasküler hastalıklar açısından prognostik değer taşıdığı gösterilmiş olmasına rağmen, acil servis ortamında STEMI hastaları üzerindeki rolü henüz yeterince araştırılmamıştır. Gereç ve Yöntemler: Bu retrospektif çalışma, Temmuz 2019 ile Ocak 2021 tarihleri arasında Muğla Eğitim ve Araştırma Hastanesi'nde gerçekleştirilmiştir. Çalışmaya, Avrupa Kardiyoloji Derneği kriterlerine göre tanı almış yetişkin STEMI hastaları dâhil edilmiştir. Birincil sonuç, 28 günlük tüm nedenlere bağlı mortalitedir. İstatistiksel analizler, mortalite prediktörlerini değerlendirmek için univariate ve Cox regresyonu, MELD-XI skorunun prediktif doğruluğunu belirlemek için ise Receiver Operating Characteristic ve Kaplan-Meier analizlerini içermektedir. Bulgular: Çalışmaya dâhil edilen 237 hastadan %8,4’ü (n=20) 28 gün içinde hayatını kaybetmiştir. Ölen hastaların MELD-XI skorları (10,72 vs. 9,44, p<0,001) ve sol ventrikül ejeksiyon fraksiyonları (LVEF) (35% vs. 50%, p<0,001) anlamlı şekilde daha yüksek bulunmuştur. MELD-XI skoru 9,76’nın üzerinde olan hastalar, %80 duyarlılık ve %70,5 özgüllükle mortalite açısından yüksek risk taşıyan grup olarak belirlenmiştir (AUC=0,813). Ayrıca, MELD-XI skoru ile LVEF arasında negatif korelasyon saptanmıştır (r=-0,223, p<0,001). Kaplan-Meier analizi, MELD-XI skoru 9,76’nın üzerinde olan hastaların 28 günlük mortalitesinin anlamlı şekilde daha yüksek olduğunu göstermiştir (Log-rank testi = 5,43, p<0,001). Mortalitenin bağımsız prediktörleri arasında MELD-XI skoru ≥9,76, yaş, acil servise kabulde kardiyak arrest, glukoz ve hemoglobin seviyeleri yer almaktadır. Sonuç: MELD-XI skoru, acil servislerde STEMI hastalarında 28 günlük mortalite riskini tahmin etmek için değerli bir prognostik araçtır. Karaciğer ve böbrek fonksiyonlarını göz önünde bulundurarak yapılan değerlendirmeler, geleneksel risk stratifikasyonunu geliştirir ve daha hedeflenmiş klinik müdahaleleri mümkün kılar.

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Cite This Article

Ertuğrul, Ş., Golcuk, Y. (2025). The Prognostic Value of MELD-XI Score in Emergency Department Patients with ST Segment Elevation Myocardial Infarction. Anatolian Journal of Emergency Medicine, Cilt: 8 Sayı: 2, 59–65. https://doi.org/10.54996/anatolianjem.1590841

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References (21)

  1. Olson JD. D-dimer: An Overview of Hemostasis and Fibrinolysis, Assays, and Clinical Applications. Adv Clin Chem. 2015;69:1-46. doi: 10.1016/bs.acc.2014.12.001.
  2. Johnson ED, Schell JC, Rodgers GM. The D-dimer assay. Am J Hematol. 2019;94(7):833-839. doi:10.1002/ajh.25482.
  3. Wells PS, Anderson DR, Rodger M, et al. Excluding pulmonary embolism at the bedside without diagnostic imaging: management of patients with suspected pulmonary embolism presenting to the emergency department by using a simple clinical model and d-dimer. Ann Intern Med. 2001;135(2):98-107. doi:10.7326/0003-4819-135-2-200107170-00010.
  4. Van Belle A, Büller HR, Huisman MV, et al. Effectiveness of managing suspected pulmonary embolism using an algorithm combining clinical probability, D-dimer testing, and computed tomography. JAMA. 2006;295(2):172-179. doi:10.1001/jama.295.2.172.
  5. Konstantinides SV, Meyer G, Becattini C, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS): The Task Force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC). Eur Respir J. 2019;54(3):1901647. doi:10.1093/eurheartj/ehz405.
  6. Vögeli A, Ghasemi M, Gregoriano C, et al. Diagnostic and prognostic value of the D-dimer test in emergency department patients: secondary analysis of an observational study. Clin Chem Lab Med. 2019;57(11):1730-1736. doi:10.1515/cclm-2019-0391.
  7. Stals MAM, Klok FA, Huisman MV. Diagnostic management of acute pulmonary embolism in special populations. Expert Rev Respir Med. 2020;14(7):729-736. doi:10.1080/17476348.2020.1753505.
  8. Sohne M, Kruip MJ, Nijkeuter M, et al. Accuracy of clinical decision rule, D-dimer and spiral computed tomography in patients with malignancy, previous venous thromboembolism, COPD or heart failure and in older patients with suspected pulmonary embolism. J Thromb Haemost. 2006;4(5):1042-1046. doi:10.1111/j.1538-7836.2006.01918.x.
  9. Mos IC, Douma RA, Erkens PM, et al. Diagnostic outcome management study in patients with clinically suspected recurrent acute pulmonary embolism with a structured algorithm. Thromb Res. 2014;133(6):1039-44. doi:10.1016/j.thromres.2014.03.050.
  10. Douma RA, le Gal G, Söhne M, et al. Potential of an age adjusted D-dimer cut-off value to improve the exclusion of pulmonary embolism in older patients: a retrospective analysis of three large cohorts. BMJ. 2010;340:c1475. doi:10.1136/bmj.c1475.
  11. Righini M, Van Es J, Den Exter PL, et al. Age-adjusted D-dimer cutoff levels to rule out pulmonary embolism: the ADJUST-PE study [published correction appears in JAMA. 2014 Apr 23-30;311(16):1694]. JAMA. 2014;311(11):1117-1124. doi:10.1001/jama.2014.2135.
  12. Righini M, Robert-Ebadi H, Le Gal G. Age-Adjusted and Clinical Probability Adapted D-Dimer Cutoffs to Rule Out Pulmonary Embolism: A Narrative Review of Clinical Trials. J Clin Med. 2024;13(12):3441. doi:10.3390/jcm13123441.
  13. Lippi G, Mullier F, Favaloro EJ. D-dimer: old dogmas, new (COVID-19) tricks. Clin Chem Lab Med. 2022;61(5):841-850. doi:10.1515/cclm-2022-0633.
  14. Lippi G, Bonfanti L, Saccenti C, Cervellin G. Causes of elevated D-dimer in patients admitted to a large urban emergency department. Eur J Intern Med. 2014;25(1):45-48. doi:10.1016/j.ejim.2013.07.012.
  15. Alshalhoub M, Alhusain F, Alsulaiman F, Alturki A, Aldayel S, Alsalamah M. Clinical significance of elevated D-dimer in emergency department patients: a retrospective single-center analysis. Int J Emerg Med. 2024;17(1):47. doi:10.1186/s12245-024-00620-6.
  16. Lippi G, Franchini M, Targher G, Favaloro EJ. Help me, Doctor! My D-dimer is raised. Ann Med. 2008;40(8):594-605. doi:10.1080/07853890802161015.
  17. Wakai A, Gleeson A, Winter D. Role of fibrin D-dimer testing in emergency medicine. Emerg Med J. 2003;20(4):319-325. doi:10.1136/emj.20.4.319.
  18. Montagnana M, Favaloro EJ, Franchini M, Guidi GC, Lippi G. The role of ethnicity, age and gender in venous thromboembolism. J Thromb Thrombolysis. 2010;29(4):489-496. doi:10.1007/s11239-009-0365-8.
  19. Legnani C, Cini M, Cosmi B, et al. Age and gender specific cut-off values to improve the performance of D-dimer assays to predict the risk of venous thromboembolism recurrence. Intern Emerg Med. 2013;8(3):229-236. doi:10.1007/s11739-011-0608-5.
  20. Palareti G, Legnani C, Antonucci E, et al. D-dimer testing, with gender-specific cutoff levels, is of value to assess the individual risk of venous thromboembolic recurrence in non-elderly patients of both genders: a post hoc analysis of the DULCIS study. Intern Emerg Med. 2020;15(3):453-462. doi:10.1111/ijlh.12426.
  21. Timp JF, Braekkan SK, Versteeg HH, Cannegieter SC. Epidemiology of cancer-associated venous thrombosis. Blood. 2013;122(10):1712-1723. doi:10.1182/blood-2013-04-460121.