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Background <p>Acute type A aortic dissection (ATAAD) remains a life-threatening cardiovascular emergency with substantial perioperative risk. Conventional cardiac risk scores often fail to capture acute multi-organ dysfunction, limiting their predictive value in emergent settings. The Model for End-Stage Liver Disease (MELD) and its variants may provide a rapid laboratory-based approach for risk stratification in ATAAD. Originally developed for hepatic disease, MELD could reflect systemic derangements relevant in ATAAD.</p> Methods <p>We retrospectively analyzed 510 ATAAD patients undergoing emergency surgery (2000–2019). MELD-I, MELD-Na (sodium-adjusted), and MELD-XI (excluding INR) were calculated from admission labs and compared with the Charlson Comorbidity Index (CCI). The primary endpoints were in-hospital mortality and 3-year all-cause mortality. Statistical analyses included receiver operating characteristics (ROC) curves, DeLong tests, multivariable logistic regression, and Kaplan–Meier survival analysis (p &lt; 0.05).</p> Results <p>In-hospital mortality was 17%. MELD-I was independently associated with in-hospital mortality and showed better discriminatory performance than CCI in this cohort. (AUC 0.642 vs. 0.502; p = 0.0002). Mortality increased stepwise across MELD-I categories. Kaplan-Meier analysis demonstrated significant differences in 3-year survival (log-rank p &lt; 0.001), with female patients showing worse outcomes (p = 0.0052).</p> Conclusions <p>The MELD-I score enables rapid, lab-based assessment of acute organ dysfunction and may perform better traditional comorbidity indices for predicting early mortality in ATAAD. While its long-term prognostic value appears limited, MELD-based stratification may still provide practical support for emergency risk assessment. The observed sex-specific survival difference should be interpreted cautiously and warrants further investigation.</p>

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Preoperative MELD score variants and survival trajectories following in acute type A aortic dissection with follow‑up up to three years

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年5月11日

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  • Freya Sophie Jenkins,
  • Ismail Dalyanoglu,
  • Luis Jaime Vallejo Castano,
  • Esma Yilmaz,
  • Mohammed Morjan,
  • Amin Thwairan,
  • Johanna Wedy,
  • Georg Ulrich Holley,
  • Artur Lichtenberg,
  • Hannan Dalyanoglu

摘要

Background

Acute type A aortic dissection (ATAAD) remains a life-threatening cardiovascular emergency with substantial perioperative risk. Conventional cardiac risk scores often fail to capture acute multi-organ dysfunction, limiting their predictive value in emergent settings. The Model for End-Stage Liver Disease (MELD) and its variants may provide a rapid laboratory-based approach for risk stratification in ATAAD. Originally developed for hepatic disease, MELD could reflect systemic derangements relevant in ATAAD.

Methods

We retrospectively analyzed 510 ATAAD patients undergoing emergency surgery (2000–2019). MELD-I, MELD-Na (sodium-adjusted), and MELD-XI (excluding INR) were calculated from admission labs and compared with the Charlson Comorbidity Index (CCI). The primary endpoints were in-hospital mortality and 3-year all-cause mortality. Statistical analyses included receiver operating characteristics (ROC) curves, DeLong tests, multivariable logistic regression, and Kaplan–Meier survival analysis (p < 0.05).

Results

In-hospital mortality was 17%. MELD-I was independently associated with in-hospital mortality and showed better discriminatory performance than CCI in this cohort. (AUC 0.642 vs. 0.502; p = 0.0002). Mortality increased stepwise across MELD-I categories. Kaplan-Meier analysis demonstrated significant differences in 3-year survival (log-rank p < 0.001), with female patients showing worse outcomes (p = 0.0052).

Conclusions

The MELD-I score enables rapid, lab-based assessment of acute organ dysfunction and may perform better traditional comorbidity indices for predicting early mortality in ATAAD. While its long-term prognostic value appears limited, MELD-based stratification may still provide practical support for emergency risk assessment. The observed sex-specific survival difference should be interpreted cautiously and warrants further investigation.