Predicting Short- and Long-Term Outcomes in Adult Heart Transplantation: Clinical Utility of MELD-XI Score

Ortiz‐Bautista, Carlos; García‐Cosio, María Dolores; Lora-Pablos, David; Antonio, Inés Ponz-de; Rodríguez-Chaverri, Adriana; Morán-Fernández, Laura; Juan-Bagudá, Javier de; Sota, Enrique Pérez-de la; Cortina-Romero, José M.; Arribas, Fernando; Delgado-Jiménez, Juan

doi:10.1016/j.transproceed.2018.08.030

Cited by 11 publications

(9 citation statements)

References 14 publications

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“…21,26 Second, the different study populations and primary endpoints contributed to differences in results. Previous studies focused on individual procedures and conditions such as heart transplantation with/ without LVAD and infective endocarditis 20,21,25 or a 30-day and 1-year mortality not undergoing ECMO. 26 However, the present study focused on the in-hospital mortality of the patients with PCS requiring VA ECMO.…”

Section: Discussionmentioning

confidence: 99%

Risk factors of acute renal injury and in-hospital mortality in adult patients with postcardiotomy cardiogenic shock requiring veno-arterial extracorporeal membrane oxygenation: utility of MELD-XI score

et al. 2021

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Background: The suitability of model for end-stage liver disease excluding international normalized ratio (MELD-XI) score to predict the incidence of acute kidney injury (AKI) and in-hospital mortality in adult patients with postcardiotomy cardiogenic shock (PCS) requiring venoarterial extracorporeal membrane oxygenation (VA ECMO) remains uncertain. This study was performed to explore whether the MELD-XI score has the association with the incidence of AKI and in-hospital mortality in these patients. Methods: Adult patients with PCS requiring VA ECMO from January 2012 to December 2017 were enrolled and first classified into AKI group ( n = 151) versus no-AKI group ( n = 132), then classified into survival group ( n = 143) versus no-survival group ( n = 140). Multivariate logistic regressions were performed to identify factors independently associated with AKI and mortality. Baseline data were defined as the first measurement available. Results: Of 283 patients, the incidence of AKI was 53.36%. The in-hospital mortality rates were 63.58% and 33.33% in patients with and without AKI (p < 0.0001). Baseline MELD-XI score, baseline serum total bilirubin (T-Bil), baseline blood urea nitrogen (BUN), baseline left ventricular ejection fraction (LVEF), sequential organ failure assessment (SOFA) score, and lactate level at ECMO initiation were shown to be associated with the AKI. Vasoactive-inotropic score (VIS) and SOFA score at ECMO initiation as well as renal failure requiring renal replacement therapy (RRT) were shown to be associated with in-hospital mortality. Conclusions: The baseline MELD-XI score, baseline BUN, baseline T-Bil, baseline LVEF, SOFA score and lactate at the initiation of ECMO were associated with AKI. AKI, SOFA score, and VIS at the initiation of ECMO were associated with in-hospital mortality, whereas MELD-XI score was not found to be associated with in-hospital mortality. A specific MELD-XI score as a threshold, as well as its sensitivity and specificity, needs to be confirmed in further studies.

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Section: Discussionmentioning

confidence: 99%

Risk factors of acute renal injury and in-hospital mortality in adult patients with postcardiotomy cardiogenic shock requiring veno-arterial extracorporeal membrane oxygenation: utility of MELD-XI score

et al. 2021

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“…To date, this is the largest single-center cohort study that has assessed the long-term prognostic significance of MELD when calculated in the acute setting. Though there have been several attempts to apply the MELD score or its surrogates (most commonly MELD-XI) in both acute and chronic cardiac conditions for estimation of mortality, results have varied considerably; Deo et al 6 and Loforte et al 8 found significant long-term prognostic value in pre-operative MELD-XI in the heart transplant population, whereas Ortiz-Bautista et al 15 noted MELD-XI to be poorly predictive and Grimm et al 16 found it to be predictive of 30-day, but not 5-year, survival rates in the same population. In a later study, it was shown that MELD-XI might be employed to identify patients on VA ECMO bridging to transplant who are at the highest risk of long-term mortality (90 days and 3 years).…”

Section: Discussionmentioning

confidence: 99%

“…5–10 However, attempts to apply the MELD score and its derivatives in the acute setting have been met with inconsistent results. 5,11–15 This study aimed to assess the value of MELD, MELD-Na, MELD-XI scores in accurately predicting 90-day mortality in patients prior to undergoing VA ECMO for refractory CS or PCCS.…”

Section: Introductionmentioning

confidence: 99%

MELD score is predictive of 90-day mortality after veno-arterial extracorporeal membrane oxygenation support

et al. 2021

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Background: The Model for End-Stage Liver Disease (MELD) score was originally described as a marker of survival in chronic liver disease. More recently, MELD and its derivatives, MELD excluding INR (MELD-XI) and MELD with sodium (MELD-Na), have been applied more broadly as outcome predictors in heart transplant, left ventricular assist device placement, heart failure, and cardiogenic shock, with additional promising data to support the use of these scores for prediction of survival in those undergoing veno-arterial extracorporeal membrane oxygenation (VA ECMO). Methods: This study assessed the prognostic impact of MELD in patients with cardiogenic shock undergoing VA ECMO via a single-center retrospective review from January 2014 to March 2020. MELD, MELD-XI, and MELD-Na scores were calculated using laboratory values collected within 48 h of VA ECMO initiation. Multivariate Cox regression analyses determined the association between MELD scores and the primary outcome of 90-day mortality. Receiver operating characteristics (ROC) were used to estimate the discriminatory power for MELD in comparison with previously validated SAVE score. Results: Of the 194 patients, median MELD was 20.1 (13.7–26.2), and 90-day mortality was 62.1%. There was a significant association between MELD score and mortality up to 90 days (hazard ratio (HR) = 1.945, 95% confidence interval (95% CI) = 1.244–3.041, p = 0.004) after adjustment for age, indication for VA ECMO, and sex. The prognostic significance of MELD score for 90-day mortality revealed an AUC of 0.645 (95% CI = 0.565–0.725, p < 0.001). MELD-Na score and MELD-XI score were not associated with mortality. Conclusion: MELD score accurately predicts long-term mortality and may be utilized as a valuable decision-making tool in patients undergoing VA ECMO.

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“…[11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26]28 In our study, the optimal cutoff based on the Youden index was 12.98 and a cutoff of 14 demonstrated significant prognostic value (odds ratio, 4.75; P < .001). There are a few studies that have found MELD-XI to be not a significant prognostic indicator 29,30 ; however, there is a high degree of congruence across most studies in the literature suggesting that an MELD-XI of 10 to 15 is indicative of a significant degree of hepatic and renal impairment.…”

Section: Discussionmentioning

confidence: 99%

MELD‐XI is predictive of mortality in venoarterial extracorporeal membrane oxygenation

et al. 2020

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Background Venoarterial extracorporeal membrane oxygenation (VA‐ECMO) is a life‐saving method of supporting critically ill patients. However, it is expensive and associated with high morbidity and mortality, making early predictive outcome modeling extremely valuable. The model for end‐stage liver disease‐excluding international normalized ratio (MELD‐XI) scoring system has been shown to have prognostic value in other critically ill patient populations. Materials and Methods A single‐center retrospective review was performed for all adult patients managed on VA‐ECMO from May 2011 to January 2018 (n = 247). Patients were included in the study if MELD‐XI scores could be calculated during the first 48 hours on ECMO (n = 187). Receiver operating characteristic curve analysis was performed for MELD‐XI in regard to in‐hospital mortality. Results Of the 187 patients, 74 (40%) patients had MELD‐XI less than 14 (low‐risk) and 113 (60%) had a MELD‐XI of 14 or greater (high‐risk). The cohorts did not differ significantly in terms of patient characteristics or indication for ECMO. The high‐risk MELD‐XI group had significantly greater mortality during index hospitalization compared to the low‐risk group (74% vs 39%; P < .0001). Quartile stratification demonstrated progressively worse prognosis associated with higher MELD‐XI scores; the fourth quartile showed a ninefold increased risk of mortality compared to the first quartile (P < .001). The AUC for predicting index hospitalization mortality was 0.69 (95% CI, 0.62‐0.77) with a Youden index (J) of 0.36 and optimized cutoff of 12.98. Conclusions These findings suggest that the MELD‐XI scoring system can be applied to the VA‐ECMO patient population early in their course of ECMO as a prognostic tool to aid in complex clinical decision making.

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Predicting Short- and Long-Term Outcomes in Adult Heart Transplantation: Clinical Utility of MELD-XI Score

Cited by 11 publications

References 14 publications

Risk factors of acute renal injury and in-hospital mortality in adult patients with postcardiotomy cardiogenic shock requiring veno-arterial extracorporeal membrane oxygenation: utility of MELD-XI score

Risk factors of acute renal injury and in-hospital mortality in adult patients with postcardiotomy cardiogenic shock requiring veno-arterial extracorporeal membrane oxygenation: utility of MELD-XI score

MELD score is predictive of 90-day mortality after veno-arterial extracorporeal membrane oxygenation support

MELD‐XI is predictive of mortality in venoarterial extracorporeal membrane oxygenation

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