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Predictive Value of the Model for End-Stage Liver Disease Score Excluding International Normalized Ratio One Year
B Szyguła-Jurkiewicz1, M Zakliczyński2, W Szczurek3
13(rd) Department of Cardiology, SMDZ in Zabrze, Medical University of Silesia, Silesian Center for Heart Diseases, Katowice, Poland.
Insights
The MELD-XI score, along with serum sodium and hs-CRP levels, effectively predicts 1-year mortality after heart transplantation. These factors help estimate postoperative risk in heart transplant recipients.
Area of Science:
- Cardiology
- Transplantation Medicine
- Medical Statistics
Background:
- The Model for End-Stage Liver Disease (MELD) score inadequately assesses multi-organ dysfunction in heart failure patients requiring anticoagulation.
- The MELD excluding INR (MELD-XI) score was developed to mitigate the impact of oral anticoagulation on the International Normalized Ratio (INR).
Purpose of the Study:
- To evaluate the preoperative MELD-XI score's ability to predict 1-year mortality following heart transplantation.
- To identify additional preoperative laboratory parameters that predict mortality after heart transplantation.
Main Methods:
- Retrospective analysis of 87 adult heart transplant recipients between 2011 and 2014.
- Collection of clinical data and laboratory parameters at admission for heart transplantation to calculate MELD-XI scores.
Main Results:
- The 1-year mortality rate was 18.4%.
- Pretransplantation MELD-XI score (HR=1.625), serum sodium concentration (HR=0.824), and highly sensitive C-reactive protein (hs-CRP) (HR=1.045) were independent predictors of 1-year mortality.
- MELD-XI (AUC=0.997) and plasma sodium concentration (AUC=0.901) demonstrated significant discriminatory power for predicting death.
Conclusions:
- The preoperative MELD-XI score is a valuable tool for estimating 1-year mortality risk in heart transplant recipients.
- Serum sodium and hs-CRP concentrations are also significant predictors of postoperative risk in these patients.
- These parameters can aid in risk stratification for heart transplant recipients within a 1-year follow-up period.
Background:
The Model for End-Stage Liver Disease (MELD) scoring system incorporating a combination of hepatic and renal laboratory parameters does not adequately reflect the degree of multi-organ dysfunction in patients with heart failure, who need oral anticoagulation. In order to exclude the impact of oral anticoagulation on the international normalized ratio (INR), we used the MELD excluding INR (MELD-XI) score. The aims of the study were to calculate the individual preoperative MELD-XI score and its ability to predict 1-year mortality after heart transplantation and to identify other preoperative laboratory prognostic parameters.
Methods:
We retrospectively analysed data of 87 consecutive adults undergoing heart transplantation between 2011 and 2014. Clinical data and laboratory parameters for the calculation of the MELD-XI score were obtained at the time of admission for the heart transplantation.
Results:
The average age of the patients was 48.8 ± 13.3 years and 68.9% of them were male. During the observation period, the mortality rate was 18.4%. Multivariate analysis of Cox proportional hazard confirmed that the pretransplantation MELD-XI score (hazard ratio [HR] = 1.625 [1.286-2.053]; P < .001), sodium serum concentration (HR = 0.824 [0.677-1.001]; P < .05) and highly sensitive C-reactive protein (hs-CRP) serum concentration (HR = 1.045 [1.008-1.083]; P < .02) were independent predictors of death during the first year after heart transplantation. Area under the receiver operating characteristic (ROC) curve (AUC) indicated a good discriminatory power of MELD-XI (AUC 0.997; P < .04) and plasma sodium concentration (AUC 0.901; P < .01) in death prediction.
Conclusions:
Our study confirms that the pretransplantation MELD-XI score, as well as serum sodium and hsCRP concentrations, may be used to estimate postoperative risk in heart transplant recipients during a 1-year follow-up.
