Matsue Yuya, Kagiyama Nobuyuki, Yamaguchi Tetsuo, Kuroda Shunsuke, Okumura Takahiro, Kida Keisuke, Mizuno Atsushi, Oishi Shogo, Inuzuka Yasutaka, Akiyama Eiichi, Matsukawa Ryuichi, Kato Kota, Suzuki Satoshi, Naruke Takashi, Yoshioka Kenji, Miyoshi Tatsuya, Baba Yuichi, Yamamoto Masayoshi, Mizutani Kazuo, Yoshida Kazuki, Kitai Takeshi
Department of Cardiology, Juntendo University and Cardiovascular, Tokyo, Japan; Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.
Department of Cardiology, The Sakakibara Heart Institute of Okayama, Okayama, Japan; Heart and Vascular Institute, West Virginia University, WV, USA.
Heart Lung Circ. 2020 Sep;29(9):1328-1337. doi: 10.1016/j.hlc.2019.12.003. Epub 2019 Dec 23.
Although liver dysfunction is one of the common complications in patients with acute heart failure (AHF), no integrated marker has been defined. The albumin-bilirubin (ALBI) score has recently been proposed as a novel, clinically-applicable scoring system for liver dysfunction. We investigated the utility of the ALBI score in patients with AHF compared to that for a preexisting liver dysfunction score, the Model of End-Stage Liver Disease Excluding prothrombin time (MELD XI) score.
We evaluated ALBI and MELD XI scores in 1,190 AHF patients enrolled in the prospective, multicentre Registry Focused on Very Early Presentation and Treatment in Emergency Department of Acute Heart Failure study. The associations between the two scores and the clinical profile and prognostic predictive ability for 1-year mortality were evaluated.
The mean MELD XI and ALBI scores were 13.4±4.8 and -2.25±0.48, respectively. A higher ALBI score, but not higher MELD XI score, was associated with findings of fluid overload. After adjusting for pre-existing prognostic factors, the ALBI score (HR 2.11, 95% CI: 1.60-2.79, p<0.001), but not the MELD XI score (HR 1.02, 95% CI: 0.99-1.06, p=0.242), was associated with 1-year mortality. Likewise, area under the receiver-operator-characteristic curves for 1-year mortality significantly increased when the ALBI score (0.71 vs. 0.74, p=0.020), but not the MELD XI score (0.71 vs. 0.72, p=0.448), was added to the pre-existing risk factors.
The ALBI score is potentially a suitable liver dysfunction marker that incorporates information on fluid overload and prognosis in patients with AHF. These results provide new insights into heart-liver interactions in AHF patients.
尽管肝功能不全是急性心力衰竭（AHF）患者常见的并发症之一，但尚未确定综合标志物。白蛋白-胆红素（ALBI）评分最近被提议作为一种针对肝功能不全的新型临床适用评分系统。我们研究了与预先存在的肝功能不全评分即终末期肝病模型（不包括凝血酶原时间，MELD XI）评分相比，ALBI评分在AHF患者中的效用。
我们评估了1190例纳入前瞻性多中心急性心力衰竭急诊科极早期就诊与治疗注册研究的AHF患者的ALBI和MELD XI评分。评估了这两种评分与临床特征之间的关联以及对1年死亡率的预后预测能力。
MELD XI评分和ALBI评分的平均值分别为13.4±4.8和-2.25±0.48。较高的ALBI评分而非较高的MELD XI评分与液体超负荷的表现相关。在对预先存在的预后因素进行校正后，ALBI评分（风险比2.11，95%置信区间：1.60 - 2.79，p<0.001）而非MELD XI评分（风险比1.02，95%置信区间：0.99 - 1.06，p = 0.242）与1年死亡率相关。同样，当将ALBI评分（0.71对0.74，p = 0.020）而非MELD XI评分（0.71对0.72，p = 0.448）添加到预先存在的危险因素中时，1年死亡率的受试者工作特征曲线下面积显著增加。
ALBI评分可能是一种合适的肝功能不全标志物，它纳入了AHF患者液体超负荷和预后的信息。这些结果为AHF患者的心肝相互作用提供了新的见解。
