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MMMELD-XI Score Is Associated With Short-Term Adverse Events in Patients With Heart Failure With Preserved Ejection
Sunying Wang1, Yuwei Wang1, Manqing Luo1
1Department of Cardiology, Shengli Clinical Medical College, Fujian Medical University, Fuzhou, China.
Abstract:
Aim: Accumulating evidence suggests that MELD-XI score holds the ability to predict the prognosis of congestive heart failure. However, most of the evidence is based on the end-stage heart failure population; thus, we aim to explore the association between the MELD-XI score and the prognosis in heart failure with preserved ejection fraction (HFpEF). Methods: A total of 30,096 patients hospitalized for HFpEF in Fujian Provincial Hospital between January 1, 2014 and July 17, 2020 with available measures of creatinine and liver function were enrolled. The primary endpoint was 60-day in-hospital all-cause mortality. Secondary endpoints were 60-day in-hospital cardiovascular mortality and 30-day rehospitalization for heart failure. Results: A total of 222 patients died within 60 days after admission, among which 75 deaths were considered cardiogenic. And 73 patients were readmitted for heart failure within 30 days after discharge. Generally, patients with an elevated MELD-XI score tended to have more comorbidities, higher NYHA class, and higher inflammatory biomarkers levels. Meanwhile, the MELD-XI score was positively correlated with NT-pro BNP, left atrial diameter, E/e' and negatively correlated with LVEF. After adjusting for conventional risk factors, the MELD-XI score was independently associated with 60-day in-hospital all-cause mortality [hazard ratio(HR) = 1.052, 95% confidential interval (CI) 1.022-1.083, P = 0.001], 60-day in-hospital cardiovascular mortality (HR = 1.064, 95% CI 1.013-1.118, P = 0.014), and 30-day readmission for heart failure (HR = 1.061, 95% CI 1.015-1.108, P = 0.009). Furthermore, the MELD-XI score added an incremental discriminatory capacity to risk stratification models developed based on this cohort. Conclusion: The MELD-XI score was associated with short-term adverse events and provided additional discriminatory capacity to risk stratification models in patients hospitalized for HFpEF.
Insights
The MELD-XI score can predict short-term adverse outcomes in patients hospitalized with heart failure with preserved ejection fraction (HFpEF). This score offers valuable insights for risk stratification in HFpEF prognosis.
Area of Science:
- Cardiology
- Nephrology
- Hepatology
Background:
- The Model for End-Stage Liver Disease-XI (MELD-XI) score is increasingly recognized for its prognostic value in congestive heart failure.
- Existing evidence primarily focuses on end-stage heart failure populations, necessitating research in other heart failure phenotypes.
- Heart failure with preserved ejection fraction (HFpEF) represents a distinct clinical entity with unique prognostic factors.
Purpose of the Study:
- To investigate the association between the MELD-XI score and prognosis in patients hospitalized with HFpEF.
- To determine if the MELD-XI score can predict short-term adverse events, including mortality and rehospitalization, in this population.
- To assess the incremental value of the MELD-XI score in existing risk stratification models for HFpEF.
Main Methods:
- A retrospective cohort study involving 30,096 patients hospitalized for HFpEF.
- Data collected from Fujian Provincial Hospital between January 1, 2014, and July 17, 2020.
- Primary endpoint: 60-day in-hospital all-cause mortality. Secondary endpoints: 60-day cardiovascular mortality and 30-day heart failure rehospitalization.
Main Results:
- Elevated MELD-XI scores correlated with increased comorbidities, higher NYHA class, and elevated inflammatory biomarkers.
- MELD-XI score showed positive correlations with NT-pro BNP, left atrial diameter, and E/e', and a negative correlation with LVEF.
- After adjusting for confounders, MELD-XI score independently predicted 60-day all-cause mortality (HR 1.052), 60-day cardiovascular mortality (HR 1.064), and 30-day HF rehospitalization (HR 1.061).
Conclusions:
- The MELD-XI score is significantly associated with adverse short-term outcomes in hospitalized HFpEF patients.
- The MELD-XI score enhances the discriminatory capacity of risk stratification models for HFpEF.
- This score may serve as a valuable tool for predicting prognosis and guiding management in HFpEF.
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