Prognostic value of the model for end-stage liver disease excluding INR score (MELD-XI) in patients with adult congenital heart disease

Abstract

Patients with adult congenital heart disease (ACHD) are at increased risk of developing late cardiovascular complication. However, little is known about the predictive factors for long-term outcome. The Model for End-Stage Liver Disease eXcluding INR (MELD-XI) score was originally developed to assess cirrhotic patients and has the prognostic value for heart failure (HF) patients. In the present study, we examined whether the score also has the prognostic value in this population. We retrospectively examined 637 ACHD patients (mean age 31.0 years) who visited our Tohoku University hospital from 1995 to 2015. MELD-XI score was calculated as follows; 11.76 x ln(serum creatinine) + 5.11 x ln(serum total bilirubin) + 9.44. We compared the long-term outcomes between the high (≥10.4) and the low (<10.4) score groups. The cutoff value of MELD-XI score was determined based on the survival classification and regression tree (CART) analysis. The major adverse cardiac event (MACE) was defined as a composite of cardiac death, HF hospitalization, and lethal ventricular arrhythmias. During a mean follow-up period of 8.6 years (interquartile range 4.4–11.4 years), MACE was noted in 51 patients, including HF hospitalization in 37, cardiac death in 8, and lethal ventricular arrhythmias in 6. In Kaplan-Meier analysis, the high score group had significantly worse MACE-free survival compared with the low score group (log-rank, P<0.001). Multivariable Cox regression analysis showed that the MELD-XI score remained a significant predictor of MACE (hazard ratio 1.36, confidence interval 1.17–1.58, P<0.001) even after adjusting for patient characteristics, such as sex, functional status, estimated glomerular filtration rate, and cardiac function. Furthermore, CART analysis revealed that the MELD-XI score was the most important variable for predicting MACE. These results demonstrate that the MELD-XI score can effectively predict MACE in ACHD patients, indicating that ACHD patients with high MELD-XI score need to be closely followed.

Prognostic value of impaired hepato‐renal function and liver fibrosis in patients admitted for acute heart failure

“…Several previous studies have demonstrated that a higher MELD‐XI score and FIB‐4 index were associated with adverse events, mainly in patients with chronic HF 11,16 . In addition, the MELD‐XI score has been shown to be useful for the prediction of prognosis in patients with ADHF 9–11 . Our study has expanded on these findings by showing that the combination of the MELD‐XI score and FIB‐4 index is a useful tool for risk stratification also in patients with ADHF.…”

“…11,16 In addition, the MELD-XI score has been shown to be useful for the prediction of prognosis in patients with ADHF. [9][10][11] Our study has expanded on these findings by showing that the combination of the MELD-XI score and FIB-4 index is a useful tool for risk stratification also in patients with ADHF.…”

“…Liver dysfunction and fibrosis in patients with HF, a condition known as cardiohepatic syndrome, 2,3,6 has a strong impact on clinical outcome and risk of death. The model for end‐stage liver disease excluding international normalized ratio (MELD‐XI) score, a robust scoring system of liver dysfunction in patients with advanced liver disease, 7,8 has been reported to predict poor outcomes in patients with ADHF 9–11 . The fibrosis‐4 (FIB‐4) index, a simple marker to assess liver fibrosis, 12,13 is also reported to be useful for prognosis predictions in patients with HF 14–16 .…”

“…The model for end-stage liver disease excluding international normalized ratio (MELD-XI) score, a robust scoring system of liver dysfunction in patients with advanced liver disease, 7,8 has been reported to predict poor outcomes in patients with ADHF. [9][10][11] The fibrosis-4 (FIB-4) index, a simple marker to assess liver fibrosis, 12,13 is also reported to be useful for prognosis predictions in patients with HF. [14][15][16] However, there is little information available on the combination of prognostic values of MELD-XI score and FIB-4 index in patients with ADHF.…”

Intensive Care Unit Management of the Adult with Congenital Heart Disease

“…The Model for End-stage Liver Disease eXcluding INR (MELD-XI) score was originally developed to assess cirrhotic patients and has prognostic value for heart failure patients as well. A retrospective cohort study showed MELD-XI remained a significant predictor of MACE in ACHD patients after adjusting for patient characteristics, including sex, functional status, estimated glomerular filtration rate, and cardiac function, while predictive modeling revealed it to be most important variable predicting MACE in this population [ 70 ]. Biomarkers may also assist in risk stratification of patients with ACHD and liver complications, with prime candidates including galectin-3 and von Willebrand factor antigen [ 71 , 72 ].…”