From the Faculty of Medicine and Dentistry, University of Alberta, Alberta, Canada.
Division of Pediatric Cardiology, University of Alberta, Alberta, Canada.
ASAIO J. 2020 Aug;66(8):933-938. doi: 10.1097/MAT.0000000000001078.
Short-term continuous-flow ventricular assist devices (STCF-VADs) are increasingly being utilized in pediatrics. End-stage liver disease (ELD) models have been associated with outcomes in adult patients on mechanical circulatory support. We sought to determine the relationship between outcomes in children on STCF-VADs and three ELD models: model for end-stage liver disease-excluding international normalized ratio (MELD-XI; all) and MELD-XI (> 1 year), PELD, and a novel score, PedMELD-XI. All patients (< 19 years) supported with STCF-VADs, between June 2009 and December 2016 were included. The MELD-XI, PELD, and PedMELD-XI scores were calculated and their association with adverse events and a composite measure of death, major bleeding, and neurologic dysfunction was analyzed. Of 32 patients, median age was 0.57 years (interquartile range [IQR], 0.10-4.43), median weight was 7.15 kg (IQR, 3.68-16.53), 53.1% had congenital heart disease, and 53.1% were male. In total, 78.1% patients experienced an adverse event (78.1% a major bleed, 25.0% neurologic dysfunction, and 15.6% death). The median MELD-XI score was 11.17 (IQR, 9.44-30.01), MELD-XI (>1 year) 9.44 (IQR, 9.44-24.33), PELD 6.00 (IQR, 4.00-13.75), and PedMELD-XI -14.91 (IQR, -18.85 to -12.25). A higher MELD-XI for all ages (13.80 vs. 9.44, p = 0.037) and less negative PedMELD-XI (-14.16 vs. -19.34, p = 0.028) scores were significantly associated with bleeding and the composite outcome. PedMELD-XI was significantly associated with death (-12.87 vs. -16.84, p = 0.041) while a trend was seen for increased MELD-XI in all ages being associated with death (31.52 vs. 10.11, p = 0.051). Last, there was no association with the models and neurologic events. MELD-XI and PedMELD-XI were significantly associated with major bleeding and the composite endpoints with PedMELD-XI also being associated with death. These results suggest that ELD models can be used to predict outcomes in this specific patient population, however, further analysis in a larger population is required.
短期持续流心室辅助装置（STCF-VAD）在儿科中越来越多地被使用。终末期肝病（ELD）模型与成人机械循环支持患者的结局有关。我们试图确定在接受 STCF-VAD 治疗的儿童中，三种 ELD 模型（不包括国际标准化比值的模型用于终末期肝病（MELD-XI；全部）和 MELD-XI（>1 年）、PELD 和一种新的评分，PedMELD-XI）与结局之间的关系。纳入了 2009 年 6 月至 2016 年 12 月期间接受 STCF-VAD 支持的所有（<19 岁）患者。计算了 MELD-XI、PELD 和 PedMELD-XI 评分，并分析了它们与不良事件和死亡、大出血和神经功能障碍的复合指标之间的关系。在 32 名患者中，中位年龄为 0.57 岁（四分位距[IQR]，0.10-4.43），中位体重为 7.15kg（IQR，3.68-16.53），53.1%患有先天性心脏病，53.1%为男性。共有 78.1%的患者发生不良事件（78.1%为大出血，25.0%为神经功能障碍，15.6%为死亡）。中位 MELD-XI 评分为 11.17（IQR，9.44-30.01），MELD-XI（>1 年）为 9.44（IQR，9.44-24.33），PELD 为 6.00（IQR，4.00-13.75），PedMELD-XI 为-14.91（IQR，-18.85 至-12.25）。各年龄段更高的 MELD-XI（13.80 比 9.44，p=0.037）和更小的负 PedMELD-XI（-14.16 比-19.34，p=0.028）评分与出血和复合结局显著相关。PedMELD-XI 与死亡显著相关（-12.87 比-16.84，p=0.041），而各年龄段更高的 MELD-XI 与死亡呈正相关（31.52 比 10.11，p=0.051）。最后，模型与神经事件没有关联。MELD-XI 和 PedMELD-XI 与大出血和复合终点显著相关，而 PedMELD-XI 也与死亡相关。这些结果表明，ELD 模型可用于预测该特定患者人群的结局，但需要在更大的人群中进行进一步分析。
