Abstract 12917: Model of End-stage Liver Disease Excluding INR (MELD-XI) Scoring System Provides the Additional Long-Term Prognostic Information to Malnutrition in Patients Admitted With Acute Decompensated Heart Failure
Backgrounds: Hospitalization for acute decompensated heart failure (ADHF) is associated with a high mortality after discharge. 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), a robust scoring system of liver dysfunction, has been shown to provide prognostic information in heart failure patients. Malnutrition is also associated with poor outcome in ADHF pts. However, there is no information available on the long-term prognostic significance of MELD-XI score in patients admitted with acute decompensated heart failure (ADHF), relating to malnutrition.
Methods and Results: We studied 303 consecutive ADHF patients discharged with survival. MELD-XI score was calculated by the following formula: 5.11·ln(bilirubin)+11.79·ln(creatinine)+9.44. Nutritional status was evaluated by Geriatric Nutritional Risk Index (GNRI) calculated as follows: 14.89·serumalbumin (g/dl) + 41.7·BMI/22. During a follow-up period of 5.0±4.3 yrs, 75 patients had cardiovascular death (CVD). At multivariate Cox analysis, MELD-XI score (p=0.0025) and GNRI (p=0.0025) were significantly independently associated with CVD, independently of systolic blood pressure, serum sodium level and prior heart failure hospitalization. ROC analysis revealed that MELD-XI score of 12 was a fair discriminator for CVD (AUC 0.70 [0.64-0.77]). In group with malnutrition (GNRI<96.5: median value), patients with high MELD-XI score (≥12) had a higher risk of CVD than those with low MELD score (43% vs 25%, p=0.02, HR 1.9 [1.1-3.3]). In group without hyponatremia (GNRI≥96.5), patients with high MELD-XI score also had a higher risk of CVD (38% vs 11%, p<0.0001, HR 4.4 [2.0-10.0]).
Conclusion: A MELD-XI scoring system could provide the additional long-term prognostic information to malnutrition in ADHF patients.
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. M. Ishimi: None. H. Hakui: None. T. Ozaki: None. Y. Satoh: None. M. Seo: None. I. Ikeda: None. M. Fukunami: None.
- © 2015 by American Heart Association, Inc.