The application of MELD-XI score for predicting short-term mortality in patients with infective endocarditis com-plicated by sepsis

HE Yu-ying; LIAO You-wan; LU Ping; GAO Jing; DENG Li-zhi

doi:10.3969/j.issn.1009-8933.2025.03.004

Abstract：Background: Renal and liver dysfunction, which are common complications in infectious diseases, are associated with poor clinical outcomes. This study aimed to evaluate the prognostic value of the Model for End-Stage Liver Disease Excluding International Normalized Ratio (MELD-XI) score for predicting short-term mortality in patients with infective endocarditis (IE) complicated by sepsis. Methods: A total of 496 consecutive IE patients complicated with sepsis at Guangdong Provincial People's Hospital were enrolled and divided into three groups according to the tertiles of MELD-XI score: <7.9 (n=164), 7.9-14.6 (n=168), and >14.6 (n=164). Major adverse clinical events (MACE) were composite endpoints that included acute heart failure, renal dialysis, stroke, and death during hospitalization. Multivariate analysis was used to explore the prognostic value of MELD-XI score. Results: In-hospital and 6-month mortality were 14.3% and 21.5%, respectively. In-hospital mortality and the incidence of MACE rose significantly with higher MELD-XI scores (mortality: 8.5% vs. 12.5% vs. 14.3%, P=0.002; Incidence of MACE: 24.4% vs. 31% vs. 51.2%, P<0.001). Receiver operating characteristic (ROC) curve analysis showed that the optimal cutoff value of MELD-XI score was 15.7 [area under the curve (AUC): 0.648, 95% CI: 0.578-0.718, P<0.001]. Multivariate regression analysis revealed that MELD-XI score>15.7 was a significantly independent risk factor for both in-hospital [adjusted odds ratio (OR): 2.27, 95% CI: 1.28-4.05, P=0.005] and 6-month mortality [adjusted hazard ratio (HR): 1.69, 95% CI: 1.13-2.53, P=0.011]. Conclusions: MELD-XI score>15.7 was independently associated with short-term mortality in IE patients complicated with sepsis, suggesting its potential value as a prognostic biomarker for risk stratification in this population. [S Chin J Cardiol 2025;26(3):164-172]