Abstract
BackgroundThe composite Model for End-Stage Liver Disease Excluding International Normalized Ratio Score (MELD-XI) is a novel tool to evaluate cardio-renal and cardio-hepatic interactions in patients with advanced heart failure (HF). However, its prognostic ability remains unclear in elderly HF patients.Methods and resultsFrom July 2014 to July 2018, patients hospitalized for HF were prospectively recruited at 16 centers. Clinical features, laboratory findings, and echocardiography results were assessed prior to discharge. Cardiovascular (CV) death and HF re-hospitalization were recorded. Of the 676 patients enrolled, 264 (39.1%) experienced CV events throughout a 1-year median follow-up period. Patients with high MELD-XI were predominantly male and had a higher prevalence of NYHA III/IV, history of HF admission, hyperuricemia, ventricular tachycardia, anemia, and ischemic heart disease. In Kaplan-Meyer analysis, patients with higher MELD-XI (≥11) scores showed a worse prognosis than did those with lower (<11) scores (log-rank p≤0.001). Multivariate Cox proportional hazards testing revealed MELD-XI as an independent predictor of CV events (HR: 1.033, 95% CI: 1.006–1.061, p = 0.015) after adjusting for age, gender, body mass index, NYHA III/IV, prior HF hospitalization, systolic blood pressure, ischemic etiology, ventricular tachycardia, anemia, BNP, and left ventricular ejection fraction.ConclusionsCardio-renal and cardio-hepatic interactions predicted CV events in aged HF patients.
Highlights
Patients with heart failure (HF) are at significant risk for cardiovascular (CV) events such as death, myocardial infarction, stroke, and hospitalization for worsening HF, especially those >60 years old [1]
Liver dysfunction has been implicated in HF outcome; cardio-hepatic syndrome is considered a disorder characterized by the development of congestive hepatopathy and subsequent cirrhosis in advanced HF patients [4]
A multicenter cohort study was conducted between July 2014 and July 2018 that included 851 hospitalized patients with decompensated HF who were treated at Shinshu University Hospital or its affiliated institutions
Summary
Patients with heart failure (HF) are at significant risk for cardiovascular (CV) events such as death, myocardial infarction, stroke, and hospitalization for worsening HF, especially those >60 years old [1]. Sufficient multi-disciplinary interventions for HF are available, some elderly patients with HF suffer non-cardiac death. Liver dysfunction has been implicated in HF outcome; cardio-hepatic syndrome is considered a disorder characterized by the development of congestive hepatopathy and subsequent cirrhosis in advanced HF patients [4]. As a composite of serum bilirubin, creatinine, and international normalized ratio (INR), the Model for End-Stage Liver Disease (MELD) is an accurate metric of the degree of liver disease and a useful decision-making tool for liver transplantation [5]. The composite Model for End-Stage Liver Disease Excluding International Normalized Ratio Score (MELD-XI) is a novel tool to evaluate cardio-renal and cardio-hepatic interactions in patients with advanced heart failure (HF). Its prognostic ability remains unclear in elderly HF patients
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