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


Autoři: Ryo Konno aff001;  Shunsuke Tatebe aff001;  Koichiro Sugimura aff001;  Kimio Satoh aff001;  Tatsuo Aoki aff001;  Masanobu Miura aff001;  Hideaki Suzuki aff001;  Saori Yamamoto aff001;  Haruka Sato aff001;  Yosuke Terui aff001;  Satoshi Miyata aff002;  Osamu Adachi aff003;  Masato Kimura aff004;  Yoshikatsu Saiki aff003;  Hiroaki Shimokawa aff001
Působiště autorů: Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan aff001;  Department of Evidence-Based Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan aff002;  Department of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan aff003;  Department of Pediatrics, Tohoku University Graduate School of Medicine, Sendai, Japan aff004
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
doi: 10.1371/journal.pone.0225403

Souhrn

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.

Klíčová slova:

bilirubin – Creatinine – Heart failure – Liver diseases – Pulmonary hypertension – Congenital heart defects – Fontan operation – Valvular diseases


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2019 Číslo 11