MELD-XI Score Predicts Early Mortality in Patients After Heart Transplantation

Grimm, Joshua C.; Shah, Ashish S.; Magruder, J. Trent; Kilic, Arman; Valero, Vicente; Dungan, Samuel P.; Tedford, Ryan J.; Russell, Stuart D.; Whitman, Glenn J.R.; Sciortino, Christopher M.

doi:10.1016/j.athoracsur.2015.07.026

Cited by 68 publications

(61 citation statements)

References 12 publications

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“…26 Baek et al 27 to predict short-term survival in patients with cirrhosis whose INR is artificially elevated by anticoagulation 28 and has subsequently been used to predict mortality after cardiac transplantation. 29,30 A recent retrospective review of Fontan patients who underwent transvenous hepatic biopsy at the time of routine cardiac catheterization revealed a positive correlation between MELD-XI and hepatic fibrosis scores on pathology (correlation coefficient 5 0.4; P 5 .003), although receiver operator characteristic analysis did not identify a score cutoff with adequate sensitivity and specificity. 31 These scores appear to be promising, but the specific cutoffs to diagnose or rule out cirrhosis in the Fontan population need to be validated.…”

Section: Diagnosis Of Cirrhosismentioning

confidence: 99%

Surveillance for liver complications after the Fontan procedure

Hilscher

Johnson

Cetta

et al. 2017

Congenital Heart Disease

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The physiological consequences of the Fontan circulation impose risk for hepatic dysfunction and may culminate in hepatic fibrosis, cirrhosis, and hepatocellular carcinoma. Consensus regarding appropriate surveillance modalities to diagnose liver disease in Fontan patients is lacking, in part due to the relative lack of strong evidence and prospective studies in this patient population. The goal of this paper is to critically review the current evidence and provide recommendations for the surveillance of hepatic complications in the post-Fontan patient population.

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Section: Diagnosis Of Cirrhosismentioning

confidence: 99%

Surveillance for liver complications after the Fontan procedure

Hilscher

Johnson

Cetta

et al. 2017

Congenital Heart Disease

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“…Furthermore, the MELD‐XI score, a modified MELD score that excludes INR during calculation because of anticoagulation,16 has been confirmed to be useful in predicting outcomes of various types of cardiac surgery including heart transplantation,17, 18 Fontan surgery,19 and transcatheter aortic valve implantation 20. In addition, the MELD‐Albumin score, which includes the serum value of albumin to replace INR, has been shown to be associated with clinical outcome following heart transplantation 15.…”

Section: Introductionmentioning

confidence: 99%

Prognostic Value of Hepatorenal Function By Modified Model for End‐stage Liver Disease (MELD) Score in Patients Undergoing Tricuspid Annuloplasty

Chen

Liu

Seto

et al. 2018

JAHA

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BackgroundThe Model for End‐stage Liver Disease excluding international normalized ratio (MELD‐XI) score and the modified MELD score with albumin replacing international normalized ratio (MELD‐Albumin) score, which reflect both liver and renal function, have been reported as predictors of adverse events in liver and heart disease. Nonetheless, their prognostic value in patients undergoing tricuspid annuloplasty has not been addressed.Methods and ResultsA total of 394 patients who underwent tricuspid annuloplasty were evaluated. Baseline clinical, laboratory, and echocardiographic parameters were recorded. Adverse outcome was defined as the occurrence of heart failure requiring admission or all‐cause mortality. Patients who underwent tricuspid annuloplasty had a high prevalence of preoperative hepatorenal dysfunction that was more common in patients with severe tricuspid regurgitation than those with mild to moderate tricuspid regurgitation. The MELD‐XI and MELD‐Albumin scores were excellent predictors of 1‐year adverse outcome (area under the curve: 0.69 and 0.75, respectively). Kaplan–Meier survival curve demonstrated that a high score on MELD‐XI (≥12.0) and MELD‐Albumin (≥10.7) was associated with an increased risk of adverse events. During a median follow‐up of 40 months, both MELD‐XI and MELD‐Albumin scores were significantly associated with adverse outcome, even after adjusting for potential confounding factors. Significant improvement of hepatorenal function at 1 year postoperation was noted only in patients who had no adverse events, not in those who experienced an adverse outcome.ConclusionsBoth MELD‐XI score and MELD‐Albumin score can provide useful information to predict adverse outcome in patients undergoing tricuspid annuloplasty. The present study supports monitoring of modified MELD score to improve preoperative risk stratification of these patients.

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“…Sern Lim 28 found remarkably similar results in a cohort of 26 patients undergoing VA‐ECMO as bridge to transplantation; 69% mortality for patients with a baseline MELD‐XI of 14 or greater compared to 31% for those with a baseline MELD‐XI less than 14. Among all the literature that investigates MELD‐XI in regard to cardiac disease processes, the cutoff value used to define the high‐risk cohort ranged from 10 to 15 11‐26,28 . In our study, the optimal cutoff based on the Youden index was 12.98 and a cutoff of 14 demonstrated significant prognostic value (odds ratio, 4.75; P < .001).…”

Section: Resultsmentioning

confidence: 70%

“…The MELD‐XI score, originally developed to account for the frequent anticoagulation use among cirrhotic patients awaiting transplant, 10 has shown clinical prognostic utility for a number of cardiac disease processes 11‐25 . It is an objective measure that requires only creatinine and total bilirubin values, making it accessible and easy to implement in a clinical setting.…”

Section: Resultsmentioning

confidence: 99%

MELD‐XI is predictive of mortality in venoarterial extracorporeal membrane oxygenation

et al. 2020

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Background Venoarterial extracorporeal membrane oxygenation (VA‐ECMO) is a life‐saving method of supporting critically ill patients. However, it is expensive and associated with high morbidity and mortality, making early predictive outcome modeling extremely valuable. The model for end‐stage liver disease‐excluding international normalized ratio (MELD‐XI) scoring system has been shown to have prognostic value in other critically ill patient populations. Materials and Methods A single‐center retrospective review was performed for all adult patients managed on VA‐ECMO from May 2011 to January 2018 (n = 247). Patients were included in the study if MELD‐XI scores could be calculated during the first 48 hours on ECMO (n = 187). Receiver operating characteristic curve analysis was performed for MELD‐XI in regard to in‐hospital mortality. Results Of the 187 patients, 74 (40%) patients had MELD‐XI less than 14 (low‐risk) and 113 (60%) had a MELD‐XI of 14 or greater (high‐risk). The cohorts did not differ significantly in terms of patient characteristics or indication for ECMO. The high‐risk MELD‐XI group had significantly greater mortality during index hospitalization compared to the low‐risk group (74% vs 39%; P < .0001). Quartile stratification demonstrated progressively worse prognosis associated with higher MELD‐XI scores; the fourth quartile showed a ninefold increased risk of mortality compared to the first quartile (P < .001). The AUC for predicting index hospitalization mortality was 0.69 (95% CI, 0.62‐0.77) with a Youden index (J) of 0.36 and optimized cutoff of 12.98. Conclusions These findings suggest that the MELD‐XI scoring system can be applied to the VA‐ECMO patient population early in their course of ECMO as a prognostic tool to aid in complex clinical decision making.

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MELD-XI Score Predicts Early Mortality in Patients After Heart Transplantation

Abstract: This is the first known study to examine the relationship between a high MELD-XI score and outcomes in patients after OHT. Patients with hepatic or renal dysfunction before OHT should be closely monitored and aggressively optimized as early mortality appears to drive long-term outcomes.

Cited by 68 publications

References 12 publications

Surveillance for liver complications after the Fontan procedure

Surveillance for liver complications after the Fontan procedure

Prognostic Value of Hepatorenal Function By Modified Model for End‐stage Liver Disease (MELD) Score in Patients Undergoing Tricuspid Annuloplasty

MELD‐XI is predictive of mortality in venoarterial extracorporeal membrane oxygenation

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