Model of End-Stage Liver Disease-eXcluding International Normalized Ratio (MELD-XI) Scoring System to Predict Outcomes in Patients Who Undergo Left Ventricular Assist Device Implantation

Critsinelis, Andre C.; Kurihara, Chitaru; Volkovicher, Nastasya; Kawabori, Masashi; Sugiura, T.; Manon, Marcos; Wang, Suwei; Civitello, Andrew B.; Morgan, Jeffrey A.

doi:10.1016/j.athoracsur.2018.02.082

Cited by 47 publications

(51 citation statements)

References 11 publications

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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%

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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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Section: Resultsmentioning

confidence: 70%

Section: Resultsmentioning

confidence: 99%

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

et al. 2020

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“…26,27 The impact of hepatic dysfunction on outcomes in advanced heart failure patients supported on an LVAD is well-studied and described. [28][29][30] These studies collectively support the negative influence of hepatic dysfunction, evidenced by elevated MELD and MELD-XI scores, on mortality and morbidity in patients undergoing LVAD implantation.…”

Section: Study Findingsmentioning

confidence: 63%

“…There is a wide variation of the threshold for elevated MELD-XI score among the studies, ranging from 14 to 17. 28,30 In our analysis, patients with hepatic steatosis tended to have increased MELD-XI score. However, upon additional analysis through Spearman's correlation test, hepatic steatosis was not correlated with MELD-XI.…”

Section: Study Findingsmentioning

confidence: 66%

Impact of hepatic steatosis on outcomes after left ventricular assist device implantation

Hong

Dufendach

Wang

et al. 2021

Journal of Cardiac Surgery

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Background: This single-center, retrospective study evaluates the impact of hepatic steatosis on outcomes after continuous-flow left ventricular assist device (LVAD) implantation.Methods: Adults undergoing LVAD implantation between 2004 and 2018 with a preoperative noncontrast-enhanced chest and abdominal computed tomography scan were included in the study. Patients were stratified as with and without radiographic signs of hepatic steatosis. The primary outcome was survival, and secondary outcomes included rates of postimplant adverse events.Results: A total of 203 patients were included in the study. 27.6% (n = 56) had radiographic signs of hepatic steatosis. Hepatic steatosis group had a higher body mass index (30.1 vs. 27.0, p < .01), model for end-stage liver disease excluding international normalized ratio score (16.8 vs. 15.1, p = .05), and incidence of diabetes (53.6% vs. 35.4%, p = .02). The rates of postimplant adverse events, including bleeding, infection, reoperation, renal failure, hepatic dysfunction, stroke, and right ventricular failure, were similar between the groups (all, p > .05). Unadjusted survival was comparable between the groups at 30-days, 90-days, 1-year, and 2-year following LVAD implantation (all, p > .05). In addition, hepatic steatosis did not impact risk-adjusted overall mortality when modeled as a categorical variable (odds ratio [OR]: 0.72, 95% confidence interval [CI]: 0.46-1.13; p = .15). Conclusions:This study demonstrates that the presence of preoperative hepatic steatosis on imaging is not predictive of increased morbidity or mortality following LVAD implantation. Despite the association with obesity, metabolic diseases, and heart failure, hepatic steatosis on imaging appears to have a limited role in patient selection or prognostication in LVAD patients.

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“…Consistent with our findings, the MELD Xi Score, that incorporates bilirubin and creatinine, which may reflect more prolonged and severe cardiomyopathy and/or higher degree of RV dysfunction, has been shown to be a predictor of poor outcomes after LVAD implantation in other studies. 14,19 Preoperative need for intra-aortic balloon pump, increased pulmonary vascular resistance, echocardiographic parameters of RV strain, increased tricuspid annulus and regurgitation, female gender, end-organ dysfunction, and DT as opposed to BTT strategies have been associated with RVF. 6,11,20 In a multivariate analysis, compared to low LVAD speed, a higher speed in the early postoperative period had a trend toward prolonged inotrope use (OR 2.3, P = .069) and toward lower mortality (HR = 0.69, P = .362).…”

Section: Discussionmentioning

confidence: 99%

Clinical characteristics and outcomes of patients requiring prolonged inotropes after left ventricular assist device implantation

et al. 2020

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Limited data exist regarding patients with continuous‐flow left ventricular assist device (LVAD) support who require long‐term inotropes. Our primary objective was to evaluate the clinical characteristics and all‐cause mortality of LVAD recipients with prolonged inotrope use (PIU). Secondary endpoints were to compare predictors of PIU, mortality, risk of late re‐initiation of inotropes, time to gastrointestinal bleed (GIB), infection, and arrhythmias. Retrospective cohort study was conducted on adult patients with primary continuous‐flow LVADs implanted from January 2008 to February 2017 and the patients were followed up through February 2018. We defined PIU as ≥14 days of inotrope support. Kaplan–Meier method, competing risk models and Cox proportional hazard models were used. Final analytic sample was 203 patients, 58% required PIU, and 10% were discharged on inotropes. There was no difference in preimplant characteristics. One‐year survival rate was 87% if no PIU required, 74% if PIU required, and 72% if discharged on inotropes. PIU was associated with longer length of stay and higher incidence of GIB. We found no association between PIU and late re‐initiation of inotropes, infection or arrhythmias. Adjusted hazard risk of death was increased in patients with PIU (HR = 1.66, P = .046), older age (HR = 1.28, P = .031), and higher creatinine levels (HR = 1.60, P = .007). Prolonged inotrope use is frequently encountered following LVAD implantation and is associated with adverse prognosis but remains a therapeutic option. Inability to wean inotropes prior to hospital discharge is a marker of patients at particularly higher risk of mortality following LVAD implantation.

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Model of End-Stage Liver Disease-eXcluding International Normalized Ratio (MELD-XI) Scoring System to Predict Outcomes in Patients Who Undergo Left Ventricular Assist Device Implantation

Cited by 47 publications

References 11 publications

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

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

Impact of hepatic steatosis on outcomes after left ventricular assist device implantation

Clinical characteristics and outcomes of patients requiring prolonged inotropes after left ventricular assist device implantation

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