Szyguła-Jurkiewicz B, Zakliczyński M, Szczurek W, Nadziakiewicz P, Gąsior M, Zembala M
3(rd) Department of Cardiology, SMDZ in Zabrze, Medical University of Silesia, Silesian Center for Heart Diseases, Katowice, Poland.
Department of Cardiosurgery, Transplantation and Cardiovascular Surgery, SMDZ in Zabrze, Medical University of Silesia, Katowice, Poland.
Transplant Proc. 2016 Jun;48(5):1703-7. doi: 10.1016/j.transproceed.2015.12.136.
The Model for End-Stage Liver Disease (MELD) scoring system incorporating a combination of hepatic and renal laboratory parameters does not adequately reflect the degree of multi-organ dysfunction in patients with heart failure, who need oral anticoagulation. In order to exclude the impact of oral anticoagulation on the international normalized ratio (INR), we used the MELD excluding INR (MELD-XI) score. The aims of the study were to calculate the individual preoperative MELD-XI score and its ability to predict 1-year mortality after heart transplantation and to identify other preoperative laboratory prognostic parameters.
We retrospectively analysed data of 87 consecutive adults undergoing heart transplantation between 2011 and 2014. Clinical data and laboratory parameters for the calculation of the MELD-XI score were obtained at the time of admission for the heart transplantation.
The average age of the patients was 48.8 ± 13.3 years and 68.9% of them were male. During the observation period, the mortality rate was 18.4%. Multivariate analysis of Cox proportional hazard confirmed that the pretransplantation MELD-XI score (hazard ratio [HR] = 1.625 [1.286-2.053]; P < .001), sodium serum concentration (HR = 0.824 [0.677-1.001]; P < .05) and highly sensitive C-reactive protein (hs-CRP) serum concentration (HR = 1.045 [1.008-1.083]; P < .02) were independent predictors of death during the first year after heart transplantation. Area under the receiver operating characteristic (ROC) curve (AUC) indicated a good discriminatory power of MELD-XI (AUC 0.997; P < .04) and plasma sodium concentration (AUC 0.901; P < .01) in death prediction.
Our study confirms that the pretransplantation MELD-XI score, as well as serum sodium and hsCRP concentrations, may be used to estimate postoperative risk in heart transplant recipients during a 1-year follow-up.
终末期肝病模型（MELD）评分系统结合了肝脏和肾脏实验室参数，但不能充分反映需要口服抗凝治疗的心力衰竭患者的多器官功能障碍程度。为了排除口服抗凝药对国际标准化比值（INR）的影响，我们使用了排除INR的MELD（MELD-XI）评分。本研究的目的是计算个体术前MELD-XI评分及其预测心脏移植后1年死亡率的能力，并确定其他术前实验室预后参数。
我们回顾性分析了2011年至2014年间连续87例接受心脏移植的成年患者的数据。计算MELD-XI评分所需的临床数据和实验室参数在心脏移植入院时获取。
患者的平均年龄为48.8±13.3岁，其中68.9%为男性。在观察期内，死亡率为18.4%。Cox比例风险多因素分析证实，移植前MELD-XI评分（风险比[HR]=1.625[1.286-2.053]；P<.001）、血清钠浓度（HR=0.824[0.677-1.001]；P<.05）和高敏C反应蛋白（hs-CRP）血清浓度（HR=1.045[1.008-1.083]；P<.02）是心脏移植后第一年死亡的独立预测因素。受试者工作特征（ROC）曲线下面积（AUC）表明MELD-XI（AUC 0.997；P<.04）和血浆钠浓度（AUC 0.901；P<.01）在死亡预测方面具有良好的辨别能力。
我们的研究证实，移植前MELD-XI评分以及血清钠和hsCRP浓度可用于评估心脏移植受者术后1年随访期间的风险。
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