Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan.
ESC Heart Fail. 2022 Oct;9(5):3113-3123. doi: 10.1002/ehf2.14046. Epub 2022 Jun 24.
The Model for End-stage Liver Disease eXcluding International normalized ratio (MELD-XI) is an established scoring system that reflects hepatorenal function. However, little is known about the prognostic value of changes in MELD-XI score during hospitalization in acute decompensated heart failure (ADHF).
We prospectively analysed 536 patients admitted for ADHF between January 2018 and December 2019. In the MELD-XI, 9.44 is the lowest possible score and considered to be normal, and values above 9.44 are classified as high. We calculated MELD-XI scores at admission and discharge and used them to divide patients into four groups depending on whether the score was high (>9.44) or normal (9.44) at each time point as follows: normal score at both measurements (persistently normal group, n = 99), high score at admission and normal score at discharge (high-to-normal group, n = 108), normal score at admission and high score at discharge (normal-to-high group, n = 24), and high score at both measurements (persistently high group, n = 305). The persistently high group had higher blood urea nitrogen, creatinine, and N-terminal pro-brain natriuretic peptide levels at both admission and discharge and significantly higher left ventricular end-diastolic, left atrial, right ventricular end-diastolic, and maximal inferior vena cava diameters at discharge. During the median follow-up period of 369 days (Q1, Q3: 97, 576), 231 (43.1%) patients reached the primary endpoint (a composite of all-cause death or re-hospitalization for heart failure). The Kaplan-Meier analysis revealed a significantly higher composite event rate in the persistently high group than in the persistently normal and high-to-normal groups (log-rank test, P < 0.001). Compared with the persistently high group, the high-to-normal group remained significantly associated with lower composite event risk after multivariate adjustment (hazard ratio, 0.30; 95% CI, 0.12-0.69; P = 0.004).
Our study suggests that changes in hepatorenal function during hospitalization are associated with the severity of heart failure and systemic congestion and that they provide useful information for predicting clinical outcomes in patients with ADHF.
终末期肝病模型排除国际标准化比值（MELD-XI）是一种反映肝肾功能的已建立的评分系统。然而，对于急性失代偿性心力衰竭（ADHF）住院期间 MELD-XI 评分变化的预后价值知之甚少。
我们前瞻性分析了 2018 年 1 月至 2019 年 12 月期间因 ADHF 住院的 536 例患者。在 MELD-XI 中，9.44 是可能的最低分数，被认为是正常的，高于 9.44 的分数被归类为高。我们在入院时和出院时计算了 MELD-XI 评分，并根据每个时间点的评分是否高（>9.44）或正常（9.44）将患者分为以下四组：两次测量的评分均正常（持续正常组，n=99）、入院时评分高而出院时评分正常（高至正常组，n=108）、入院时评分正常而出院时评分高（正常至高组，n=24）和两次测量的评分均高（持续高组，n=305）。持续高组在入院和出院时的血尿素氮、肌酐和 N 端脑利钠肽前体水平均较高，出院时左心室舒张末期、左心房、右心室舒张末期和最大下腔静脉直径也明显较高。在中位数为 369 天（Q1，Q3：97，576）的中位随访期间，231（43.1%）例患者达到了主要终点（全因死亡或因心力衰竭再次住院的复合终点）。Kaplan-Meier 分析显示，持续高组的复合事件发生率明显高于持续正常组和高至正常组（对数秩检验，P<0.001）。与持续高组相比，多变量调整后高至正常组的复合事件风险仍显著降低（风险比，0.30；95%CI，0.12-0.69；P=0.004）。
我们的研究表明，住院期间肝肾功能的变化与心力衰竭的严重程度和全身充血有关，为预测 ADHF 患者的临床结局提供了有用的信息。
