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

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.