Prognostic value of the modified model for end-stage liver disease (MELD) score including albumin in acute heart failure

Abstract

Background Liver and renal function evaluated by the model for end-stage liver disease (MELD) score, the MELD excluding the international normalized ratio (MELD_XI) score and the MELD including sodium (MELD_sodium) score have been considered predictors of adverse events for patients with acute heart failure (AHF). However, the prognostic value of the MELD including albumin (MELD_albumin) score in patients with AHF has not been assessed. Methods A total of 466 patients with AHF were prospectively evaluated. We compared the accuracy of the 4 MELD score formulas using the time-dependent receiver operating characteristic (ROC) curve and corresponding areas under the curve (AUC). Results During a median follow-up period of 34 months, 196 deaths occurred. In the fully adjusted Cox regression model, standardized hazard ratios with 95% confidence interval expressing the risk of all-cause mortality were 1.22 (1.06–1.40), 1.20 (1.04–1.39), 1.23 (1.06–1.42) and 1.21 (1.05–1.41) for MELD, MELD_XI, MELD_sodium and MELD_albumin scores, respectively. The MELD_albumin score showed the best prognostic accuracy (AUC = 0.658) for the prediction of long-term all-cause mortality, followed by the MELD_sodium score (AUC = 0.590), the MELD score (AUC = 0.580), and the MELD_XI score (AUC = 0.544); the MELD_albumin score performs significantly more accurate than MELD and MELD_XI score for predicting the risk of all-cause mortality. Considering reclassification, MELD_albumin score increased the net reclassification improvement over and beyond MELD (13.1%, P = 0.003), MELD_XI (14.8%, P = 0.002), and MELD_sodium (11.9%, P = 0.006) scores for all-cause mortality. Conclusions The MELD_albumin score increases risk stratification of all-cause mortality over and beyond the MELD score and the other modified MELD scores in patients with acute heart failure.

Association Between Waist Circumference and the Prevalence of (Pre) Hypertension Among 27,894 US Adults

“…cdc.gov/nchs/nhanes/index.htm). The NHANES database has been extensively analyzed in a series of publications in scientific and technical journals worldwide (14)(15)(16). All the involved participants were selected using a stratified multistage probabilistic sampling method to ensure a representative sample.…”

Child–Turcotte–Pugh score as a model for organ allocation in liver transplantation, perhaps old is still gold

“…S Liao et al assessed the utility of a modified MELD score incorporating albumin to stratify the risk of all-cause mortality, including cardiovascular mortality, in patients with acute heart failure. 5 Their findings revealed an increased hazard ratio (HR) of 1.27 for all-cause mortality and HR of 1.31 for cardiovascular mortality, emphasizing the importance of albumin as a prognostic marker even beyond the scope of liver disease.…”