Backgrounds:
Cardiohepatic interactions have been a focus of attention among heart failure. A model of end-stage liver disease excluding INR (MELD-XI) is a robust scoring system of liver dysfunction, and a high score has been shown to be associated with poor prognosis in patients with heart failure. Prediction of mode of death (sudden cardiac death (SCD) and pump failure death (PFD)) in patients with heart failure may facilitate decisions about specific medications or devices. However, there is no information available on the prognostic significance of MELD-XI in patients admitted with acute decompensated heart failure (ADHF), from the viewpoint of mode of death.
Methods and Results:
We studied 303 consecutive patients admitted with ADHF and discharged with survival. MELD-XI score was calculated by the following formula: 5.11[[Unable to Display Character: ･]]ln(bilirubin)+11.79[[Unable to Display Character: ･]]ln(creatinine)+9.44. During a follow-up period of 5.0±4.3 yrs, 37 patients had SCD and 27 patients had PFD. At multivariate Cox analysis, MELD-XI score was significantly independently associated with SCD (p=0.002) and PFD (p=0.003). Receiver-operator curve analysis revealed that MELD-XI of 11 and 13 was fair discriminators for SCD (AUC 0.667(95%CI 0.575-0.758), p=0.001; sensitivity 78% and specificity 48%) and PFD (AUC 0.764(95%CI 0.683-0.845; sensitivity 74% and specificity 69%), p<0.0001), respectively. Patients with higher MELD-XI score had significantly a higher risk of not only SCD (17% vs 6%, p=0.0005, adjusted HR: 3.19 (95%CI 1.44-7.08) but also PFD (20% vs 3%, p<0.0001, adjusted HR: 4.53 (95%CI 1.72-12.07)), compared to those with lower MELD-XI score.
Conclusion:
A MELD-XI scoring system might predict not only sudden cardiac death but also pump failure death in patients admitted with ADHF.
P1489Prognostic value of the combination of simple risk index and model of end-stage liver disease excluding INR (MELD-XI) scoring system in patients admitted for acute decompensated heart failure
