Impaired hepato‐renal function defined by the MELD XI score as prognosticator in acute heart failure

Biegus, Jan; Zymliński, Robert; Sokolski, Mateusz; Siwołowski, Paweł; Gajewski, Piotr; Nawrocka‐Millward, Sylwia; Poniewierka, Elżbieta; Jankowska, Ewa A.; Banasiak, Waldemar; Ponikowski, Piotr

doi:10.1002/ejhf.644

Cited by 64 publications

(96 citation statements)

References 19 publications

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“…24 The MELD-Na may therefore be more clinically meaningful in heart failure other than MELD scoring. Importantly however, the lack of association with mid-term outcomes for both scores after multivariable adjustment conflicts with previous findings, 5,18 and does not support their prognostic utility in patients with AHF apart from more transitional markers. Interestingly, there was a modest correlation between alternative MELD scoring and the cardiorenal axis: cystatin C, NT-proBNP, and plasma renin activity; suggesting that the prognostic use of MELD scoring in heart failure may be, in part, its representation of renal comorbidity – but that it may be less prognostically informative than these markers individually.…”

Section: Discussioncontrasting

confidence: 94%

“…10 Therefore, we hypothesized that alternative MELD scores may be associated with treatment response and prognosis in acute heart failure (AHF). Because prior analyses have not adjusted for renal function in their multivariable models, 5 a strong prognostic factor in AHF, 11 we also aim to incorporate this into our analysis. The Diuretic Strategies in Patients with Acute Decompensated Heart Failure (DOSE-AHF) and the Low-dose Dopamine or Low-dose Nesiritide in Acute Heart Failure with Renal Dysfunction (ROSE-AHF) together provide a well-characterized cohort, well-suited to study the clinical implications of these alternative MELD scores in AHF.…”

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confidence: 99%

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Implications of Alternative Hepatorenal Prognostic Scoring Systems in Acute Heart Failure (from DOSE-AHF and ROSE-AHF)

Grodin

Gallup

Anstrom

et al. 2017

The American Journal of Cardiology

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Because hepatic dysfunction is common in patients with heart failure, the Model for End-Stage Liver Disease (MELD) may be attractive for risk-stratification. Although alternative scores such as the MELD-XI or MELD-Na may be more appropriate in heart failure populations, the short-term clinical implications of these in patients with acute heart failure (AHF) are unknown. The MELD-XI and MELD-Na were calculated at baseline in 453 patients with AHF in the DOSE-AHF and ROSE-AHF trials. The correlations and associations for each score with cardiorenal biomarkers, short-term endpoints at 72 hours including worsening renal function and clinical events to 60 days were determined. The median MELD-XI and MELD-Na was 16 and 17, respectively. Both were correlated with baseline cystatin C, NT-proBNP, and plasma renin activity (P<0.003 for all). MELD-XI≤16 and MELD-Na≤17 were associated with a slight increase in cystatin C (P<0.02 for both), higher diuretic efficiency (P<0.001 for both), but not with change in global VAS scores (P>0.05 for both) at 72 hours. Neither score was associated with CRS or worsening heart failure (P>0.05 for all). Similarly, both the MELD-XI and MELD-Na were not associated with 60-day death/any re-hospitalization and 60-day death/heart failure re-hospitalization in adjusted analyses when analyzes as a dichotomous or continuous variable (P>0.05 for all). The alternative MELD scores correlated with baseline cardiorenal biomarkers. In conclusion, lower baseline MELD scoring was associated with higher diuretic efficiency and a slight increase in cystatin C through 72 hours. However, MELD-Na and MELD-XI were not predictive of 60-day clinical events.

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Section: Discussioncontrasting

confidence: 94%

mentioning

confidence: 99%

Implications of Alternative Hepatorenal Prognostic Scoring Systems in Acute Heart Failure (from DOSE-AHF and ROSE-AHF)

Grodin

Gallup

Anstrom

et al. 2017

The American Journal of Cardiology

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“…In the ESCAPE (Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness) trial, which reviewed longitudinal liver function in patients with acute decompensated heart failure, liver function was significantly improved upon treatment at 6‐month follow‐up 28. In another study that evaluated patients with acute heart failure, an increase in the MELD‐XI score during hospital stay was related to increased risk of mortality at 1‐year follow‐up 32. Building on these results, we have demonstrated that bilirubin, aspartate transaminase, estimated glomerular filtration rate, MELD‐XI score, and MELD‐Albumin score were all improved in patients who were free of adverse events 1 year post‐TA.…”

Section: Discussionmentioning

confidence: 54%

“…Nonetheless, the accuracy of the MELD score that includes INR assessment in evaluating hepatopathy in patients who require anticoagulation is arguable. The MELD‐XI14, 20, 32 and MELD‐Albumin15 scores were designed specifically to exclude INR assessment in order to better reflect hepatopathy in patients prescribed anticoagulation. For example, a study that evaluated 343 patients undergoing heart transplantation evaluation demonstrated that MELD‐XI, but not MELD score, was associated with adverse events in those prescribed anticoagulation 14.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Value of Hepatorenal Function By Modified Model for End‐stage Liver Disease (MELD) Score in Patients Undergoing Tricuspid Annuloplasty

Chen

Liu

Seto

et al. 2018

JAHA

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BackgroundThe Model for End‐stage Liver Disease excluding international normalized ratio (MELD‐XI) score and the modified MELD score with albumin replacing international normalized ratio (MELD‐Albumin) score, which reflect both liver and renal function, have been reported as predictors of adverse events in liver and heart disease. Nonetheless, their prognostic value in patients undergoing tricuspid annuloplasty has not been addressed.Methods and ResultsA total of 394 patients who underwent tricuspid annuloplasty were evaluated. Baseline clinical, laboratory, and echocardiographic parameters were recorded. Adverse outcome was defined as the occurrence of heart failure requiring admission or all‐cause mortality. Patients who underwent tricuspid annuloplasty had a high prevalence of preoperative hepatorenal dysfunction that was more common in patients with severe tricuspid regurgitation than those with mild to moderate tricuspid regurgitation. The MELD‐XI and MELD‐Albumin scores were excellent predictors of 1‐year adverse outcome (area under the curve: 0.69 and 0.75, respectively). Kaplan–Meier survival curve demonstrated that a high score on MELD‐XI (≥12.0) and MELD‐Albumin (≥10.7) was associated with an increased risk of adverse events. During a median follow‐up of 40 months, both MELD‐XI and MELD‐Albumin scores were significantly associated with adverse outcome, even after adjusting for potential confounding factors. Significant improvement of hepatorenal function at 1 year postoperation was noted only in patients who had no adverse events, not in those who experienced an adverse outcome.ConclusionsBoth MELD‐XI score and MELD‐Albumin score can provide useful information to predict adverse outcome in patients undergoing tricuspid annuloplasty. The present study supports monitoring of modified MELD score to improve preoperative risk stratification of these patients.

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“…[1–3] The laboratory-based model for end-stage liver disease (MELD) score reflects the function of the kidney, liver, and extrinsic coagulation pathway and might be used as a general prognostic tool for the assessment of patients. [4,5] …”

Section: Introductionmentioning

confidence: 99%

MELD score as a predictor of mortality, length of hospital stay, and disease burden

Roth

Chrobak

Schädelin³

et al. 2017

Medicine

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Impaired hepato‐renal function defined by the MELD XI score as prognosticator in acute heart failure

Abstract: Impairment of hepato-renal function defined by the MELD XI score is common and carries unfavourable prognosis in AHF patients.

Cited by 64 publications

References 19 publications

Implications of Alternative Hepatorenal Prognostic Scoring Systems in Acute Heart Failure (from DOSE-AHF and ROSE-AHF)

Implications of Alternative Hepatorenal Prognostic Scoring Systems in Acute Heart Failure (from DOSE-AHF and ROSE-AHF)

Prognostic Value of Hepatorenal Function By Modified Model for End‐stage Liver Disease (MELD) Score in Patients Undergoing Tricuspid Annuloplasty

MELD score as a predictor of mortality, length of hospital stay, and disease burden

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