Abstract 12660: Model of End-Stage Liver Disease Excluding INR (MELD-XI) Scoring System Provides the Long-Term Prognostic Information in Patients Admitted With Acute Decompensated Heart Failure, Regardless of Reduced or Preserve Left Ventricular Ejection Fraction
Backgrounds: Liver dysfunction has a prognostic impact on the outcome of patients with advanced 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. However, there is little information available on the long-term prognostic significance of MELD-XI score in patients admitted with acute decompensated heart failure (ADHF), relating to reduced or preserved left ventricular ejection fraction (HFrEF or HFpEF).
Methods and Results: We studied 303 consecutive patients admitted with ADHF and discharged with survival (HFrEF(LVEF<50%); n=163, HFpEF;n=140). 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, 75 patients had cardiovascular death (CVD). Receiver-operator curve analysis revealed that MELD-XI score of 12 was a fair discriminator for CVD (AUC 0.704 (95%CI 0.635-0.772), p<0.0001; sensitivity 67% and specificity 62%). In HFrEF group, MELD-XI score was significantly independently associated with CVD (p=0.0037) at multivariate Cox analysis, and patients with high MELD-XI score (≥12) had a higher risk of CVD than those with low MELD score (46% vs 24%, p=0.0038, hazard ratio: 2.20 (95%CI 1.27-3.79)). In HFpEF group, MELD-XI score was also significantly independently associated with CVD (p=0.005) at multivariate Cox analysis, and patients with high MELD-XI score (≥12) had a higher risk of CVD (34% vs 8%, p<0.0001, hazard ratio: 6.25 (95%CI 2.59-15.05)).
Conclusion: A MELD-XI scoring system would provide the long-term prognostic information in patients admitted with ADHF, regardless of HFrEF or HFpEF.
Author Disclosures: T. Yamada: None. T. Morita: None. Y. Furukawa: None. S. Tamaki: None. Y. Iwasaki: None. M. Kawasaki: None. A. Kikuchi: None. T. Kondo: None. T. Kawai: None. S. Takahashi: None. M. Ishimi: None. H. Hakui: None. T. Ozaki: None. Y. Satoh: None. M. Seo: None. M. Fukunami: None.
- © 2014 by American Heart Association, Inc.