MELD-Score Associated Outcomes after Surgery for Infective Endocarditis

Background: In patients with endocarditis, failure of other organ systems often becomes apparent after surgery. The MELD Score (Model for End-stage Liver Disease) is usually used to estimate prognosis of patients with liver failure. It is calculated based on bilirubin, INR, and creatinine levels and may rise to values of 40 points. We evaluated preoperative MELD Score in patients with infective endocarditis and their associated postoperative outcome.

Methods: This study is a retrospective observational study. MELD Score was calculated in 130 surgical patients with infective endocarditis treated from 2021 to 2023 and was categorized into: low MELD-Score (<9 points), intermediate (10–19 points), high (20–29), and very high (30–40).

Results: Number of patients in MELD groups was as follows: Low: 73 patients (56.1%); intermediate: 48 patients (36.9%); high: 7 patients (5.4%); and very high: 2 patients (1.5%). Mean age of patients was not significantly different between MELD categories and was 63.3 (±13.6) years overall; gender was also not significantly different. With increasing MELD Score, EuroSCORE II also increased, and means were: 14.5 ± 17.6% for low MELD; 18.1 ± 17.1% for intermediate; 19.9 ± 20.1% for high; and 65.1 ± 6.6% for very high MELD. Double valve procedures were necessary in 16.4% (12/73) in low MELD and in 21.0% (12/57) in the higher MELD groups combined (p = 0.50); the rate of UFO procedures was not different between different MELD categories (p = 0.95). 30-day mortality increased by every MELD category: 15.1% (11/73) in low, 29.2% (14/48) in intermediate, 28.6% (2/7) in high, and 100% (2/2) in very high MELD category (p = 0.01). Also, higher MELD categories were associated with need for post-op dialysis (low: 17.8% [13/73]; intermediate: 45.8% [22/48]; high: 100% [7/7]; very high: 100% [2/2]; p < 0.01) and rate of liver failure (9.6% [7/73], 12.5% [6/48], 14.3% [1/7], 100% [2/2]; p < 0.01). Rates of post-op delirium, rethoracotomy, and re-infection during follow-up did not differ between MELD categories. In multivariate logistic regression analysis, MELD and EuroSCORE II were independent predictors of 30-day mortality and also both were independent predictors of liver failure.

Conclusion: MELD score was strongly associated with postoperative mortality and morbidity in patients with infective endocarditis. Patients with a MELD Score over 30 are futile. Larger studies should investigate if MELD assessment adds any benefit over traditional assessment of EuroSCORE II.

Publication History

Article published online:
11 February 2025