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End-Stage Liver Disease Models and Outcomes in Pediatric Patients Supported With Short-Term Continuous-Flow
Getanshu Malik1, Tara Pidborochynski2, Holger Buchholz3
1From the Faculty of Medicine and Dentistry, University of Alberta, Alberta, Canada.
Insights
End-stage liver disease (ELD) models, including MELD-XI and a novel PedMELD-XI score, can predict adverse outcomes in pediatric patients receiving short-term continuous-flow ventricular assist devices (STCF-VADs). These scores showed significant associations with bleeding and composite endpoints, with PedMELD-XI also predicting mortality.
Area of Science:
- Pediatric Cardiology
- Mechanical Circulatory Support
- Liver Disease Prognostication
Background:
- Short-term continuous-flow ventricular assist devices (STCF-VADs) are increasingly used in pediatric patients.
- End-stage liver disease (ELD) models have demonstrated utility in predicting outcomes for adult patients on mechanical circulatory support.
- The applicability of ELD models to predict outcomes in pediatric STCF-VAD patients requires investigation.
Purpose of the Study:
- To evaluate the association between established ELD models (MELD-XI, PELD) and a novel score (PedMELD-XI) with adverse events in pediatric STCF-VAD patients.
- To determine the predictive value of these ELD scores for specific adverse outcomes, including death, major bleeding, and neurologic dysfunction.
- To assess the utility of ELD models in stratifying risk for children supported by STCF-VADs.
Main Methods:
- Retrospective analysis of pediatric patients (<19 years) supported with STCF-VADs from June 2009 to December 2016.
- Calculation of MELD-XI (all ages and >1 year), PELD, and PedMELD-XI scores for all included patients.
- Statistical analysis to determine the association between ELD scores and adverse events, including a composite outcome of death, major bleeding, and neurologic dysfunction.
Main Results:
- Of 32 pediatric patients, 78.1% experienced adverse events, with major bleeding being the most common (78.1%).
- Higher MELD-XI (all ages) and less negative PedMELD-XI scores were significantly associated with major bleeding and the composite outcome.
- PedMELD-XI was significantly associated with death, while MELD-XI showed a trend towards association with mortality. No association was found with neurologic events.
Conclusions:
- ELD models, specifically MELD-XI and PedMELD-XI, demonstrate significant associations with major bleeding and composite adverse outcomes in pediatric STCF-VAD patients.
- The novel PedMELD-XI score showed promise in predicting mortality in this cohort.
- These findings suggest that ELD models can aid in outcome prediction for pediatric patients on STCF-VADs, warranting further validation in larger studies.
Abstract:
Short-term continuous-flow ventricular assist devices (STCF-VADs) are increasingly being utilized in pediatrics. End-stage liver disease (ELD) models have been associated with outcomes in adult patients on mechanical circulatory support. We sought to determine the relationship between outcomes in children on STCF-VADs and three ELD models: model for end-stage liver disease-excluding international normalized ratio (MELD-XI; all) and MELD-XI (> 1 year), PELD, and a novel score, PedMELD-XI. All patients (< 19 years) supported with STCF-VADs, between June 2009 and December 2016 were included. The MELD-XI, PELD, and PedMELD-XI scores were calculated and their association with adverse events and a composite measure of death, major bleeding, and neurologic dysfunction was analyzed. Of 32 patients, median age was 0.57 years (interquartile range [IQR], 0.10-4.43), median weight was 7.15 kg (IQR, 3.68-16.53), 53.1% had congenital heart disease, and 53.1% were male. In total, 78.1% patients experienced an adverse event (78.1% a major bleed, 25.0% neurologic dysfunction, and 15.6% death). The median MELD-XI score was 11.17 (IQR, 9.44-30.01), MELD-XI (>1 year) 9.44 (IQR, 9.44-24.33), PELD 6.00 (IQR, 4.00-13.75), and PedMELD-XI -14.91 (IQR, -18.85 to -12.25). A higher MELD-XI for all ages (13.80 vs. 9.44, p = 0.037) and less negative PedMELD-XI (-14.16 vs. -19.34, p = 0.028) scores were significantly associated with bleeding and the composite outcome. PedMELD-XI was significantly associated with death (-12.87 vs. -16.84, p = 0.041) while a trend was seen for increased MELD-XI in all ages being associated with death (31.52 vs. 10.11, p = 0.051). Last, there was no association with the models and neurologic events. MELD-XI and PedMELD-XI were significantly associated with major bleeding and the composite endpoints with PedMELD-XI also being associated with death. These results suggest that ELD models can be used to predict outcomes in this specific patient population, however, further analysis in a larger population is required.
