Centre for Heart Diseases, Military Hospital, Wroclaw, Poland.
Department of Heart Diseases, Medical University, Wroclaw, Poland.
Eur J Heart Fail. 2016 Dec;18(12):1518-1521. doi: 10.1002/ejhf.644. Epub 2016 Oct 6.
Multi-organ dysfunction often complicates the natural course of acute heart failure (AHF) and identifies patients with poor prognosis. The MELD score (Model of End-Stage Liver Dysfunction) combines data reflecting liver and kidney function, which makes it a potentially useful tool for the assessment of patients with AHF. The aim of this study was to assess the prognostic utility of the MELD score in patients with AHF.
The MELD score was calculated on admission and during hospital stay (days 2-3) using a formula that does not take into account the international normalized ratio (MELD XI). The study population consisted of 203 AHF patients (mean age 65 ± 12 years, 76% male). The mean MELD XI score was -14.8 ± 4.5 points on admission and 13.9 ± 4.3 points during hospitalization. Contributors of elevated MELD XI score at baseline and during hospital stay were isolated increase in creatinine in 22-25%, isolated increase in bilirubin in 17-19%, and abnormal values of both in 40-46% of patients. During 1-year follow-up, 67 (33%) patients died. After adjustment for well-established prognosticators, MELD XI score at baseline and during hospital stay were significant predictors of poor outcome [hazard ratio (95% confidence interval): 1.11 (1.05-1.2) and 1.14 (1.09-1.2), respectively, P < 0.001]. An increase in the MELD XI score during hospital stay occurred in 31% of patients and was related to increased risk of death at 1 year [1.97 (1.2-3.2), P < 0.005].
Impairment of hepato-renal function defined by the MELD XI score is common and carries unfavourable prognosis in AHF patients.
多器官功能障碍常使急性心力衰竭（AHF）的自然病程复杂化，并确定预后不良的患者。MELD 评分（终末期肝病模型）结合了反映肝肾功能的数据，使其成为评估 AHF 患者的有用工具。本研究旨在评估 MELD 评分在 AHF 患者中的预后价值。
使用不考虑国际标准化比值（MELD XI）的公式在入院时和住院期间（第 2-3 天）计算 MELD 评分。研究人群包括 203 名 AHF 患者（平均年龄 65 ± 12 岁，76%为男性）。入院时 MELD XI 评分平均为-14.8 ± 4.5 分，住院期间为 13.9 ± 4.3 分。导致基线和住院期间 MELD XI 评分升高的因素分别是肌酐升高（22-25%）、胆红素升高（17-19%）和两者均异常（40-46%）。在 1 年的随访期间，67（33%）名患者死亡。在调整了既定预后因素后，基线和住院期间的 MELD XI 评分是不良结局的显著预测因素[风险比（95%置信区间）：1.11（1.05-1.2）和 1.14（1.09-1.2），均 P<0.001]。住院期间 MELD XI 评分升高发生在 31%的患者中，与 1 年死亡风险增加相关[1.97（1.2-3.2），P<0.005]。
MELD XI 评分定义的肝肾功能障碍在 AHF 患者中很常见，且预后不良。
