Prognostic value of impaired hepato‐renal function assessed by the MELD‐XI score in patients undergoing percutaneous mitral valve repair

Spieker, Maximilian; Hellhammer, Katharina; Wiora, Julian; Klose, Simon; Zeus, Tobias; Jung, Christian; Saeed, Diyar; Horn, Patrick; Kelm, Malte; Westenfeld, Ralf

doi:10.1002/ccd.27906

Cited by 13 publications

(18 citation statements)

References 35 publications

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“…To our best knowledge, our study demonstrated to the first time in the medical literature that MELD-XI score can be used as a predictor of in-hospital mortality among patients with CRT-D or ICD that presented with either decompensated heart failure or device shock or electrical storm. While previous studies have reported that MELD-XI score may predict both short and long-term prognosis in various patient populations (13)(14)(15)22,23,25,26), we demonstrated that it significantly predicted in-hospital mortality. We demonstrated that a cut-off value of ≥ 13.88 for MELD-XI score was associated with a significant risk of in-hospital mortality with a relatively fair sensitivity and specificity.…”

Section: Discussioncontrasting

confidence: 75%

“…Toplamda 16 (%15,1) hasta hastanede öldü. Hastanede ölen hastaların ortanca MELD-XI skoru yaşayanlardan anlamlı şekilde daha yüksekti (11,80 (0,59-28,98)'e karşılık 15,24 (9,(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)64); p<0,05). İkili lojistik regresyon analizinde MELD-XI skorunun hastane içi mortalitenin bağımsız öngördürücüsü olduğu gösterildi (X 2 =1,229 (%95 CI 1,06-1,43); p<0,05).…”

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MELD-XI Score in Hospitalized Heart Failure Patients with Cardiac Electronic Devices

2019

GMJ

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Objective: MELD-XI (Model for End-Stage Liver Disease Excluding INR) score predicts mortality in patients with heart failure. Herein, we assessed the role of MELD-XI score in predicting in-hospital mortality among heart failure patients having intracardiac cardioverter defibrillator (ICD) or cardiac resynchronization therapy with defibrillator backup (CRT-D) who presented with appropriate device shock or acute decompensated heart failure. Methods: We reviewed the medical records of patients with implantable cardioverter defibrillator or cardiac resynchronization therapy with defibrillator backup admitted to coronary care unit with acute decompensated heart failure or appropriate implantable device shocks between 01 January 2013 and 01 November 2018. MELD-XI score was compared between the deceased and surviving patients. The correlation of MELD-XI score with in-hospital mortality was sought. Results: There were 106 coronary care unit admissions of 67 patients (52 (77.6%) males and 15 (22.4%) females), who had a mean age of 64.8 (range 19-93) years. Eighty-eight (83.0%) admissions were for acute decompensated heart failure and 18 (17.0%) for appropriate device shock and/or electrical storm. A total of 16 (15.1%) patients died at hospital. The median MELD-XI score of the patients who died at hospital was significantly greater than that of the survivors (11.80 (0.59-28.98) vs 15.24 (9.11-24.64); p<0.05). A binary logistic regression analysis showed that MELD-XI score was a significant independent predictor of in-hospital mortality (X 2 =1.229 (%95 CI 1.06-1.43); p<0.05). Conclusion: MELD-XI score successfully predicts in-hospital mortality among patients with ICD or CRT-D admitted with acute decompensated heart failure or appropriate implantable electronic device shocks.

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Section: Discussioncontrasting

confidence: 75%

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MELD-XI Score in Hospitalized Heart Failure Patients with Cardiac Electronic Devices

2019

GMJ

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“…In addition, the predictive value of the MELD-XI score for the composite outcome within 2 years after TMVR was greater than those of eGFR and total bilirubin, separately. The optimal cut-off value of the MELD-XI score is different in various populations of HF [5,7,8,21,22]. We used one of the cut-off values previously reported and found a similar validity of the cut-off value in the present study.…”

Section: Discussionsupporting

confidence: 70%

“…Furthermore, the MELD-XI score is reported as a risk-stratification tool in patients with valvular interventions [20,21]. In patients undergoing TMVR, Spieker et al previously reported the association between the MELD-XI score and all-cause mortality during one-year follow-up in a single-center population [22]. In the present study, we validated the use of this score on a multicenter large-scale cohort of TMVR patients, and additionally assessed the impact of MELD-XI score on the incidence of HF hospitalization.…”

Section: Discussionmentioning

confidence: 99%

Prognostic value of hepatorenal function following transcatheter edge-to-edge mitral valve repair

et al. 2021

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Background Hepatorenal dysfunction is a strong prognostic predictor in patients with heart failure. However, the prognostic impact of the hepatorenal dysfunction in patients undergoing transcatheter mitral valve repair (TMVR) has not been well studied. Methods In consecutive patients who underwent edge-to-edge TMVR at three German centers, the model for end-stage liver disease excluding international normalized ratio (MELD-XI) score was calculated as 5.11 × ln [serum total bilirubin (mg/dl)] + 11.76 × ln [serum creatinine (mg/dl)] + 9.44. Patients were stratified into high (> 11) or low (≤ 11) MELD-XI score of which an incidence of the composite outcome, consisting of all-cause mortality and heart failure hospitalization, within 2 years after TMVR was assessed. Results Of the 881 patients, the mean MELD-XI score was 11.0 ± 5.9, and 415 patients (47.1%) had high MELD-XI score. The MELD-XI score was correlated with male, effective regurgitant orifice area, and tricuspid regurgitation severity and inversely related to left ventricular ejection fraction. Patients with high MELD-XI score had a higher incidence of the composite outcome than those with low MELD-XI score (47.7% vs. 29.8%; p < 0.0001), and in multivariable analysis, the high MELD-XI score was an independent predictor of the composite outcome [adjusted hazard ratio (HR) 1.34; 95% confidence interval (CI) 1.02–1.77; p = 0.04). Additionally, the MELD-XI score as a continuous variable was also an independent predictor (adjusted HR 1.02; 95% CI 1.00–1.05; p = 0.048). Conclusions The MELD-XI score was associated with clinical outcomes within 2 years after TMVR and can be a useful risk-stratification tool in patients undergoing TMVR.

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“…Previous studies also focused on the role of liver dysfunction in various clinical scenarios. Thus the role of cholestasis was evaluated in acute decompensated heart failure 21 and high as well as increasing MELD displayed worse outcome in patients after surgery for infective endocarditis 22 . Moreover, MELD independently predicted mortality rates in patients undergoing cardiac surgery 23 or implantation of left ventricular assist devices 24 .…”

Section: Discussionmentioning

confidence: 99%

Association between high dose catecholamine support and liver dysfunction following cardiac surgery

et al. 2020

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Background Cardiac surgery using cardiopulmonary bypass is a well‐established procedure. However, up to 20% to 30% of patients require high dose vasopressor or inotropic support following surgery, enhancing the risk of organ dysfunction and impacting mortality. Nonalcoholic fatty liver disease (NAFLD) is a frequent finding in these patients and may be involved in the pathophysiology of vasoplegia and cardiac failure. Methods Retrospective analysis of 463 patients undergoing elective cardiac surgery in 2014 at our institution. NAFLD was defined using the NAFLD fibrosis score and the vasoactive‐inotropy score was used to determine postoperative vasopressor and inotropic dependency. Results Patients with NAFLD more often presented with high vasopressor or inotropic support compared to patients without NAFLD, resulting in significant differences after 6 hours (n = 20 [27.0%] of 74 patients), 12 hours (n = 20 [27.0%] of 74 patients), and on the first postoperative day (n = 12 [16.4%] of 73 patients) of intensive care unit (ICU) treatment. Multivariate analysis revealed time of catecholamine application (P = .001), preoperative left ventricular ejection fraction (P = .001), type of surgery (P = .001), model of endstage liver disease on hospital admission (P = .002), pre‐existing pulmonary hypertension (P = .004) and NAFLD‐time interaction (P = .05) as independent predictors of high vasopressor and inotropic support. Patients with NAFLD had higher degrees of extrahepatic organ dysfunction, were more dependent on hemodialysis, spent more days in the ICU and within the hospital. Patients with NAFLD and high catecholamine support had the highest mortality rates among the study population. Conclusions NAFLD is a common finding in elective cardiac surgery patients. Anesthesiologists and intensivists should be sensitive for the specific risk profile of this population.

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Prognostic value of impaired hepato‐renal function assessed by the MELD‐XI score in patients undergoing percutaneous mitral valve repair

Cited by 13 publications

References 35 publications

MELD-XI Score in Hospitalized Heart Failure Patients with Cardiac Electronic Devices

MELD-XI Score in Hospitalized Heart Failure Patients with Cardiac Electronic Devices

Prognostic value of hepatorenal function following transcatheter edge-to-edge mitral valve repair

Association between high dose catecholamine support and liver dysfunction following cardiac surgery

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