Nadziakiewicz P, Szyguła-Jurkiewicz B, Pacholewicz J, Zakliczyński M, Przybyłowski P, Krauchuk A, Łowicka M, Zembala M
Department of Cardiac Anaesthesia and Intensive Care SUM, Silesian Centre for Heart Diseases, Zabrze, Poland.
Clinical Department of Cardiac Anaesthesia and Intensive Care (SMDZ), Zabrze, Medical University of Silesia, Katowice, Poland.
Transplant Proc. 2018 Sep;50(7):2075-2079. doi: 10.1016/j.transproceed.2018.02.160. Epub 2018 Mar 15.
Model for End-Stage Liver Disease (MELD) score predicts multisystem dysfunction and death in patients with heart failure (HF). Left ventricular assist devices (LVADs) have been used for the treatment of end-stage HF.
We evaluated the prognostic values of MELD, MELD-XI, and MELD-Na scores in patients with POLVAD MEV LVAD.
We retrospectively analyzed data of 25 consecutive pulsatile flow POLVAD MEV LVAD patients (22 men and 3 women) divided in 2 groups: Group S (survivors), 20 patients (18 men and 2 women), and Group NS (nonsurvivors), 5 patients (4 men and 1 woman). Patients were qualified in INTERMACS class 1 (7 patients) and class 2 (18 patients). Clinical data and laboratory parameters for MELD, MELD-XI, and MELD-Na score calculation were obtained on postoperative days 1, 2, and 3. Study endpoints were mortality or 30 days survival. MELD scores and complications were compared between Groups S and NS.
20 patients survived, and 5 (4 men and 1 woman) died during observation. Demographics did not differ. MELD scores were insignificantly higher in patients who died (Group 2). Values were as follows: 1. MELD preoperatively (21.71 vs 15.28, P = .225) in day 1 (22.03 vs 17.14, P = .126), day 2 (20.52 vs 17.03, P = .296); 2. MELD-XI preoperatively (19.28 vs 16.39, P = .48), day 1 (21.55 vs 18.14, P = .2662), day 2 (20.45 vs 17.2, P = .461); and 3. MELD-Na preoperatively (20.78 vs 18.7, P = .46), day 1 23.68 vs 18.12, P = .083), day 2 (22.00 vs 19.19, P = .295) consecutively.
The MELD scores do not identify patients with pulsatile LVAD at high risk for mortality in our series. Further investigation is needed.
终末期肝病模型（MELD）评分可预测心力衰竭（HF）患者的多系统功能障碍和死亡情况。左心室辅助装置（LVAD）已用于治疗终末期HF。
我们评估了MELD、MELD-XI和MELD-Na评分在接受搏动性体外膜肺氧合（ECMO）支持的左心室辅助装置（POLVAD MEV LVAD）患者中的预后价值。
我们回顾性分析了25例连续的搏动性血流POLVAD MEV LVAD患者（22例男性和3例女性）的数据，分为2组：S组（存活者），20例患者（18例男性和2例女性），和NS组（非存活者），5例患者（4例男性和1例女性）。患者符合体外膜肺氧合（ECMO）支持的左心室辅助装置（INTERMACS）1级（7例患者）和2级（18例患者）标准。在术后第1、2和3天获取用于计算MELD、MELD-XI和MELD-Na评分的临床数据和实验室参数。研究终点为死亡率或30天生存率。比较S组和NS组之间的MELD评分和并发症。
20例患者存活，5例（4例男性和1例女性）在观察期间死亡。人口统计学特征无差异。死亡患者（第2组）的MELD评分略高。数值如下：1. 术前MELD（21.71对15.28，P = 0.225），第1天（22.03对17.14，P = 0.126），第2天（20.52对17.03，P = 0.296）；2. 术前MELD-XI（19.28对16.39，P = 0.48），第1天（21.55对18.14，P = 0.2662），第2天（20.45对17.2，P = 0.461）；3. 术前MELD-Na（20.78对18.7，P = 0.46），第1天（23.68对18.12，P = 0.083），第2天（22.00对19.19，P = 0.295）。
在我们的系列研究中，MELD评分不能识别搏动性LVAD患者中死亡风险高的患者。需要进一步研究。
