Hepatic Dysfunction in Ambulatory Patients with Heart Failure - Application of the MELD Scoring System for Outcome Prediction.
J Am Coll Cardiol. 2013 Apr 3;
Authors: Kim MS, Kato TS, Farr M, Wu C, Givens RC, Collado E, Mancini DM, Schulze PC
OBJECTIVES: We evaluated the Model of End-stage Liver Disease (MELD) score and its modified versions, established measures of liver dysfunction, as a tool to evaluate HTx urgency in ambulatory HF patients. BACKGROUND: Liver abnormalities have prognostic impact on the outcome of patients with advanced heart failure. METHODS: We retrospectively evaluated 343 patients undergoing HTx evaluation between 2005 and 2009. The prognostic effectiveness of MELD/MELDNa/MELD-XI for endpoint events defined as death/HTx/ventricular assist device (VAD) requirement was evaluated in our cohort and in subgroups of patients on and off oral anticoagulation. RESULTS: The MELD and MELDNa score were excellent predictors for 1 year endpoint events (AUC: 0.71 and 0.73, respectively). High scores (>12) were strongly associated with poor survival at one year (MELD: 69.3% vs. 90.4%, p<0.0001; and MELDNa: 70.4% vs. 96.9%, p<0.0001). Increased scores were associated with increased risk for HTx (HR 1.10, 95% CI) 1.06-1.14; p<0.0001 for both scores) which was independent of other known risk factors (MELD p=0.0055 and MELDNa: p=0.0088). Anticoagulant use was associated with poor survival at 1 year (73.7% vs. 86.4%; p=0.0118) and the statistical significance of MELD/MELDNa was higher in patients not on oral anticoagulation. MELD-eXcluding INR (XI) was a fair but limited predictor of the endpoint events in patients on oral anticoagulation. CONCLUSION: Assessment of liver dysfunction using the MELD scoring system provides additional risk information in patients with ambulatory heart failure.
PMID: 23563127 [PubMed - as supplied by publisher]