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Application of the Revised Cardiac Risk Index to the Model for End-Stage Liver Disease Score Improves the Prediction
Y-S Park1, Y-J Moon1, I-G Jun1
1Department of Anesthesiology and Pain Medicine, Laboratory for Cardiovascular Dynamics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Insights
The Revised Cardiac Risk Index (RCRI) adds value to the Model for End-Stage Liver Disease (MELD) score for predicting cardiac events after liver transplantation. This combination improves risk stratification for better patient outcomes.
Area of Science:
- Cardiology
- Hepatology
- Transplantation Surgery
Background:
- The Revised Cardiac Risk Index (RCRI) is established for estimating perioperative cardiac event risk.
- Its specific utility in predicting cardiac events following liver transplantation (LT) requires further validation.
Purpose of the Study:
- To assess the additive predictive value of the RCRI to the Model for End-Stage Liver Disease (MELD) score for postoperative cardiac events in LT patients.
Main Methods:
- Retrospective analysis of 1429 patients undergoing LT.
- Cardiac events defined as myocardial infarction, death, or combined events within 30 days post-surgery.
- Multivariate logistic regression and ROC curve analysis to evaluate RCRI and MELD score predictability.
Main Results:
- 3.1% of patients experienced cardiac events within 30 days.
- Both MELD score and RCRI independently predicted postoperative cardiac events.
- The combined MELD-RCRI model demonstrated significantly improved prediction compared to MELD alone (C-statistic 0.800 vs 0.757, P=0.030).
Conclusions:
- RCRI provides additive value to the MELD score for preoperative risk stratification.
- This combined approach enhances the prediction of 30-day cardiac events after LT.
Introduction:
Although the revised cardiac risk index (RCRI) is a useful tool for estimating the risk of postoperative cardiac events, whether it improves the prediction of cardiac events in patients undergoing liver transplantation (LT) has not been sufficiently demonstrated.
Methods:
We retrospectively analyzed 1429 patients who underwent LT. Cardiac events were defined as myocardial infarction, death, or combined events within 30 days after surgery. The RCRI was defined as the number of independent predictors including high-risk surgery, ischemic heart disease, congestive heart failure, cerebrovascular disease, insulin treatment, and creatinine level >2 mg/dL. Multivariate logistic regression analysis was performed to identify factors independently associated with cardiac events. The additive predictability of RCRI for the Model for End-Stage Liver Disease (MELD) score was assessed using receiver operating characteristic curve analysis.
Results:
Forty-four (3.1%) cardiac events occurred within 30 days after surgery. Both the MELD score (adjusted odds ratio [aOR], 1.05; P = .005) and RCRI (aOR, 4.35; P < .001 for RCRI score 2; aOR, 6.27; P = .009 for RCRI score 3 compared with RCRI score 1) independently predicted postoperative 30-day cardiac events. The model with MELD score plus RCRI was significantly more predictive for postoperative 30-day cardiac events than the model with MELD score alone (C-statistics 0.800 vs 0.757; P = .030).
Conclusions:
For preoperative risk stratification, RCRI showed additive value to MELD score in predicting postoperative 30-day cardiac events after LT.
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