Liver Dysfunction Assessed by Model for End-Stage Liver Disease Excluding INR (MELD-XI) Scoring System Predicts Adverse Prognosis in Heart Failure

Abstract

AimsLiver dysfunction due to heart failure (HF) is often referred to as cardiac or congestive hepatopathy. The composite Model for End-Stage Liver Disease excluding INR (MELD-XI) is a robust scoring system of liver function, and a high score is associated with poor prognosis in advanced HF patients with a heart transplantation and/or ventricular assist device. However, the impact of MELD-XI on the prognosis of HF patients in general remains unclear.Methods and ResultsWe retrospectively analyzed 562 patients who were admitted to our hospital for the treatment of decompensated HF. A MELD-XI score was graded, and patients were divided into two groups based on the median value of MELD-XI score: Group L (MELD-XI <10, n = 289) and Group H (MELD-XI ≥10, n = 273). We compared all-cause mortality and echocardiographic findings between the two groups. In the follow-up period (mean 471 days), 104 deaths (62 cardiac deaths and 42 non-cardiac deaths) were observed. The event (cardiac death, non-cardiac death, all-cause death)-free rate was significantly higher in group L than in group H (logrank P<0.05, respectively). In the Cox proportional hazard analysis, a high MELD-XI score was found to be an independent predictor of cardiac deaths and all-cause mortality in HF patients. Regarding echocardiographic parameters, right atrial and ventricular areas, inferior vena cava diameter, and systolic pulmonary artery pressure were higher in group H than in group L (P<0.05, respectively).ConclusionsThe MELD-XI scoring system, a marker of liver function, can identify high-risk patients with right heart volume overload, higher pulmonary arterial pressure and multiple organ failure associated with HF.

Prognostic Relevance of Liver Stiffness Assessed by Transient Elastography in Patients With Acute Decompensated Heart Failure

“…The composite Model for End-Stage Liver Disease excluding INR (MELD-XI) score was calculated for evaluation of liver function: a high score relates to an adverse clinical outcome in patients with HF. 13 The MELD-XI score was calculated as follows: [5.116 log (total bilirubin)+11.766 log (creatinine)+9.44], with scores <1 given a value of 1. 13 The study protocol and use of patient information was approved by the Nihon University Itabashi Hospital's Ethics Committee, and informed consent was given by all patients.…”

A Peripheral Blood Transcriptome Biomarker Test to Diagnose Functional Recovery Potential in Advanced Heart Failure

“…The ability to predict preoperatively this risk for the individual patient before AdHF surgical/interventional therapies and the impact of this risk on the associated long-term survival prognosis would be a very important component of clinical decision-making and management. Currently, we have our validated clinical biomarkers and algorithms [51][52][53][54][55][56][57][58][59][60][61][62][63][64][65][66] for AdHF and organ failure risk prediction.…”

“…Therefore, our goal was to use leukocyte immune-biology information to develop a preoperative test, which would precisely predict postoperative outcomes in the individual AdHF patient. We utilized the widely accepted SOFA [64] and MELD-XI [61,65,66] scores as quantitative assessment tools to interpret the PBMC data and to develop a predictive leukocyte biomarker. We specifically hypothesized that one of the most significant clinical outcome parameters for AdHF patients undergoing MCS is the probability of organ function improvement from 1 day before to 8 days after surgery.…”

“…First and foremost, this means that all available pre-intervention data need to be analyzed for their long-term outcome prediction capacity. None of the current established clinical scoring and prediction tools integrate immune function parameters [51][52][53][54][55][57][58][59][60][61][64][65][66][131][132][133][134][135][136]. They have the tendency to be imprecisely calibrated in estimating risk among severely ill patients [56,57], making the therapeutic recommendation with the best survival estimate for the individual patient very difficult.…”

Biomarkers in Heart Failure

“…Abe, et al recently analyzed 562 patients who were admitted for the treatment of decompensated heart failure. 66) A MELD-XI score was graded, and patients were divided into two groups based on the median MELD-XI score. They showed that rates of cardiac death, non-cardiac death, and all-cause death were significantly higher in the high MELD-XI group than in the low MELD-XI group.…”