Prognostic value of liver dysfunction assessed by MELD-XI scoring system in patients undergoing transcatheter aortic valve implantation

Abstract

BackgroundThere are limited data regarding the influence of liver dysfunction on outcomes of transcatheter aortic valve implantation (TAVI). Model for End-stage Liver Disease eXcluding International normalized ratio (MELD-XI) score, which was originally developed for patients with cirrhosis awaiting liver transplantation, has been reported as a predictor of heart disease. The aim of this study was to investigate the prognostic value of MELD-XI score for patients undergoing TAVI. MethodsData from the prospectively maintained Optimized transCathEter vAlvular iNtervention (OCEAN-TAVI) multicenter registry were collected in 749 patients who underwent TAVI between October 2013 and August 2015. MELD-XI score was calculated as follows: 11.76×Ln (creatinine)+5.11×Ln (total bilirubin)+9.44. Patients were categorized based on MELD-XI score>10 or ≤10, and compared with regard to clinical characteristics and outcomes of TAVI. ResultsHigher MELD-XI score was associated with lower 30-day survival (95.6% vs 98.5%, P=0.03). Kaplan–Meier analysis revealed that higher MELD-XI score also was associated with lower 6-month survival (P<0.01). Multivariate Cox regression analysis showed that MELD-XI score was an independent predictor of 6-month cumulative mortality. Receiver operating characteristic analysis revealed that MELD-XI score showed better accuracy in predicting 6-month mortality compared with Logistic European System for Cardiac Operative Risk Evaluation, European System for Cardiac Operative Risk Evaluation II, and Society of Thoracic Surgeons scores (area under the curve=0.67, 0.58, 0.57, and 0.60, respectively). ConclusionEvaluation of liver dysfunction according to MELD-XI score provides additional risk information for patients undergoing TAVI.