Hepatic dysfunction in ambulatory patients with heart failure: application of the MELD scoring system for outcome prediction.
J Am Coll Cardiol
; 61(22): 2253-2261, 2013 Jun 04.
Article
en En
| MEDLINE
| ID: mdl-23563127
ABSTRACT
OBJECTIVES:
This study evaluated the Model for End-Stage Liver Disease (MELD) score and its modified versions, which are established measures of liver dysfunction, as a tool to assess heart transplantation (HTx) urgency in ambulatory patients with heart failure.BACKGROUND:
Liver abnormalities have a 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 and 2 modifications (MELDNa [includes serum sodium levels] and MELD-XI [does not include international normalized ratio]) for endpoint events, defined as death/HTx/ventricular assist device requirement, was evaluated in our cohort and in subgroups of patients on and off oral anticoagulation.RESULTS:
The MELD and MELDNa scores were excellent predictors for 1-year endpoint events (areas under the curve 0.71 and 0.73, respectively). High scores (>12) were strongly associated with poor survival at 1 year (MELD 69.3% vs. 90.4% [p < 0.0001]; MELDNa 70.4% vs. 96.9% [p < 0.0001]). Increased scores were associated with increased risk for HTx (hazard ratio 1.10 [95% confidence interval 1.06 to 1.14]; p < 0.0001 for both scores), which was independent of other known risk factors (MELD p = 0.0055; MELDNa p = 0.0083). 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 receiving oral anticoagulation therapy. MELD-XI was a fair but limited predictor of the endpoint events in patients receiving oral anticoagulation therapy.CONCLUSIONS:
Assessment of liver dysfunction according to the MELD scoring system provides additional risk information in ambulatory patients with heart failure.
Texto completo:
1
Banco de datos:
MEDLINE
Asunto principal:
Índice de Severidad de la Enfermedad
/
Enfermedad Hepática en Estado Terminal
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Insuficiencia Cardíaca
Tipo de estudio:
Observational_studies
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Prognostic_studies
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Risk_factors_studies
Límite:
Female
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Humans
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Male
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Middle aged
Idioma:
En
Año:
2013
Tipo del documento:
Article