Abstract 12047: Model of End-Stage Liver Disease Scoring in Patients With Acute Decompensated Heart Failure
Study Purpose: The goal of this analysis was to assess the association between the Model of End-stage Liver Disease-eXcluding INR (MELD-XI) scoring system and clinical outcomes among patients admitted with acute decompensated heart failure (ADHF).
Methods: We conducted a post hoc analysis using data from the Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness (ESCAPE) trial, a large multicenter trial of patients treated for ADHF. Among 346 individuals, we analyzed the association between admission MELD-XI scores and a composite endpoint of death, re-hospitalization, or heart transplant (Htx). Baseline MELD-XI scores were categorized by tertile values (≤27.4 vs. ≥27.4 to ≤33.2 vs. ≥33.2) and by dichotomization (≤39 vs. ≥39).
Results: Patients in the highest tertile of MELD-XI scores exhibited a significantly increased risk (Hazard Ratio [HR]=1.32; 95% CI 1.11-1.58) for re-hospitalization/death/Htx compared to the first two tertiles (figure 1). When the MELD-XI data was dichotomized, patients with MELD-XI score ≥ 39 (15% of patients) were associated with a significantly increased risk of clinical events (HR=1.86; 95% CI 1.31-2.64) and a lower 6-month event-free survival (23%) compared to the patients with a lower MELD score (46%; P≤0.001)(figure 2).
Conclusion: We found a large percentage of patients had very elevated MELD-XI scores, but we also found these higher scores to be associated with poor survival and greater risk of clinical events. This study suggests that admission MELD-XI scoring could be utilized as a predictor of survival and risk of clinical events in patients undergoing treatment of acute decompensated heart failure.
- © 2013 by American Heart Association, Inc.