Hepatorenal dysfunction predicts operative mortality after triple valve surgery: Utility of MELD‐Na

Abstract

Background Despite significant advancements in operative techniques and myocardial protection, triple valve surgery (TVS) remains a formidable operation with a relatively high in‐hospital mortality. We evaluated the prognostic value of Model for End‐stage Liver Disease score including sodium (MELD‐Na) for mortality after TVS and its predictive value when incorporated in the EuroSCORE risk model. Methods We performed a retrospective cohort study of 61 consecutive patients who underwent TVS from November 2005 to June 2016. Demographics, clinical, biochemical, and operative data were collected and analyzed. Results Median follow‐up duration was 8.0 years. The majority (70.5%) of patients suffered from rheumatic heart disease and underwent mechanical double valve replacement with tricuspid valve repair. There were six operative deaths (9.84%), with the most common cause of death being multiorgan failure (83.3%). In 26.2% of the cohort, the MELD‐Na score was moderately elevated at 9 to 15. A small fraction (4.9%) had a severely elevated MELD‐Na greater than 15. Patients with a MELD‐Na greater than 9 had a higher unadjusted rate of operative mortality, prolonged ventilation, need for dialysis and acute liver failure after TVS. Hierarchical logistic regression was performed using logistic EuroSCORE as the base model. After risk adjustment, each point of MELD‐Na score increase was associated with 1.405 times increase in odds of operative mortality. The regression analysis was repeated by incorporating individual components of the MELD‐Na score, including bilirubin, sodium, and albumin. All three biochemical parameters were significantly associated with operative mortality Conclusion MELD‐Na score as a quantifier of hepatorenal dysfunction is sensitive and specific for operative mortality after triple valve surgery.

Hepatorenal dysfunction in patients with chronic thromboembolic pulmonary hypertension

“…Although specific normal values or defined cutoffs for the MELDNa score in the context of right heart failure are currently unavailable, the MELDNa score has been utilized as a prognostic marker in various diseases, including triple valve surgery patients and heart failure patients listed for transplant ( 14 , 37 ). Notably, the observed MELDNa threshold consistently hovered around 10 in these populations.…”

“…There are various methods for assessing hepatorenal dysfunction, for example liver and kidney sonography, which we and others have proven to be feasible and highly relevant for patients with pulmonary hypertension (PH) ( 10 , 11 ). A more simple yet comprehensive method for assessing hepatorenal dysfunction is based on the Model for End-stage Liver Disease Sodium (MELDNa) score ( 12 – 14 ). The MELDNa score is usually used for patients with liver cirrhosis or end-stage liver disease, particularly for organ allocation, but its prognostic and clinical relevance has also been shown in patients with various other diseases, including left ventricular failure, primary TR, and congenital heart disease ( 6 , 15 ).…”

Predicting ICU Mortality in Rheumatic Heart Disease: Comparison of XGBoost and Logistic Regression

“…The MELD score was a clinical predictor in the logistic regression analysis of hospital mortality patients with RHD in ICUs and was used to assess cardiovascular-disease-related secondary liver dysfunction ( 33 ), and also was taken as a measure of liver and kidney dysfunction. Quantitative indicators had high specificity and sensitivity for predicting the operative mortality of RHD valve surgery ( 34 ).…”