Prognostic value of preoperative MELD-albumin score in patients undergoing heart transplant

Heart transplantation (HT) is the ultimate treatment option for patients with end-stage heart failure, and its prognostic evaluation has consistently been a focal point in clinical research. This article primarily explores the impact of the pre-operative Model for End-Stage Liver Disease (MELD) and its derivative scoring systems on the prognosis of HT patients.

A retrospective analysis was conducted on the data of patients who underwent HT at Shanghai Changhai Hospital from January 2018 to January 2024. All included patients were scored using the MELD and its upgraded versions (MELD-XI, MELD-albumin). Initially, the preoperative baseline of survival group and non-survival group were compared. Subsequently, the association between various MELD scores and patient prognosis was analyzed using the Receiver Operating Characteristic (ROC) curve. Based on the higher Area Under the Curve (AUC), MELD-albumin was selected as the research indicator. Patients were then divided into high-score group and low-score group according to its optimal cutoff value, and the perioperative data of the two groups were compared.

A total of 170 patients were included in this study, with 159 patients (93.5%) in survival group and 11 patients (6.5%) in non-survival group. Comparison of preoperative and intraoperative baseline data between the two groups revealed that the non-survival group had a lower preoperative platelet count, higher preoperative creatinine levels and BNP levels, a lower left ventricular ejection fraction (LVEF), and higher scores in MELD, MELD-XI, and MELD-albumin compared to the survival group. ROC analysis demonstrated that the AUC values for preoperative MELD scores in predicting in-hospital mortality were 0.806, 0.842 for MELD-XI, and 0.843 for MELD-albumin. MELD-albumin was selected as the primary indicator. Based on the optimal cutoff value of 8.4, patients were divided into low-score group (MELD-albumin ≤8.4, 128 cases) and high-score group (MELD-albumin >8.4, 42 cases) to explore its relationship with perioperative prognosis in HT. The results showed statistical differences between the two groups in preoperative white blood cell count, platelet count, monocyte count, bilirubin, creatinine, BNP, international normalized ratio (INR), and procalcitonin levels, while no statistical differences were observed in intraoperative data. Regarding prognosis, the high-score group had a higher mortality rate (19% vs. 2.3%, P = 0.0004) and a higher proportion of patients suffering postoperative acute kidney injury (AKI) (38% vs. 18.7%, P = 0.023) and receiving continuous renal replacement therapy (CRRT) (14.3% vs. 4.7%, P = 0.039).

This study confirms that the preoperative MELD-albumin score is an independent predictor of in-hospital mortality in HT patients, and its optimal cutoff value of 8.4 can effectively distinguish between high-risk and low-risk populations.