Xu Hongjie, Wang He, Chen Shisong, Chen Qian, Xu Tianyu, Xu Zhiyun, Sun Yangyong
Department of Cardiovascular Surgery, Changhai Hospital, Naval Medical University, Shanghai, China.
Department of Cardiothoracic Surgery, Affiliated People's Hospital of Jiangsu University, Zhenjiang, China.
Front Cardiovasc Med. 2022 Jul 1;9:932142. doi: 10.3389/fcvm.2022.932142. eCollection 2022.
Though the prognostic value of the model for end-stage liver disease (MELD) score in tricuspid surgery was confirmed, the unstable international normalized ratio (INR) may affect the evaluation effectiveness of the MELD score for isolated tricuspid valve replacement (ITVR). The aim of the study was to assess the prognostic value of modified MELD for ITVR.
A total of 152 patients who underwent ITVR were evaluated. The adverse outcome was defined as in-hospital mortality after surgery. The receiver operating characteristic (ROC) curve analysis demonstrated that a modified MELD score with albumin replacing INR (MELD-albumin) score presented well prognostic value [area under the curve (AUC) = 0.731, = 0.006] for in-hospital mortality. Through Cox regression and further interval validation, the MELD-albumin score was identified as an independent predictor for in-hospital mortality. The optimal cutoff value of MELD-albumin was identified as 8.58 through maximally selected log-rank statistics. In addition, restricted cubic spline analysis demonstrated the linear inverse relationship between MELD-albumin and hazard ratio (HR) for in-hospital mortality. Kaplan-Meier analysis illustrated that in-hospital mortality was increased significantly in the high MELD-albumin (MELD-albumin ≥8.58) group than in the low MELD-albumin group (MELD-albumin <8.58; < 0.001). Furthermore, high MELD-albumin was associated with lower body mass index (BMI), the incidence of lower extremities edema and moderate drinking history, and the MELD-albumin score was correlated with the value of aspartate transaminase (AST), alanine transaminase (ALT), and albumin. Furthermore, the incidence of renal failure ( = 0.003) and pulmonary infection ( = 0.042) was increased significantly in the high MELD-albumin group.
The MELD-albumin score could provide prognostic value for ITVR. In addition, the MELD-albumin score was useful in risk stratification and patient selection for patients with tricuspid regurgitation (TR) prior to ITVR.
尽管终末期肝病模型（MELD）评分在三尖瓣手术中的预后价值已得到证实，但不稳定的国际标准化比值（INR）可能会影响MELD评分对单纯三尖瓣置换术（ITVR）的评估效果。本研究旨在评估改良MELD对ITVR的预后价值。
共评估了152例行ITVR的患者。不良结局定义为术后住院死亡率。受试者工作特征（ROC）曲线分析表明，用白蛋白替代INR的改良MELD评分（MELD-白蛋白评分）对住院死亡率具有良好的预后价值[曲线下面积（AUC）=0.731，P=0.006]。通过Cox回归和进一步的区间验证，MELD-白蛋白评分被确定为住院死亡率的独立预测因素。通过最大选择对数秩统计，MELD-白蛋白的最佳截断值被确定为8.58。此外，受限立方样条分析显示MELD-白蛋白与住院死亡率的风险比（HR）之间呈线性反比关系。Kaplan-Meier分析表明，高MELD-白蛋白（MELD-白蛋白≥8.58）组的住院死亡率显著高于低MELD-白蛋白组（MELD-白蛋白<8.58；P<0.001）。此外，高MELD-白蛋白与较低的体重指数（BMI）、下肢水肿发生率和中度饮酒史相关，且MELD-白蛋白评分与天冬氨酸转氨酶（AST）、丙氨酸转氨酶（ALT）和白蛋白的值相关。此外，高MELD-白蛋白组的肾衰竭发生率（P=0.003）和肺部感染发生率（P=0.042）显著增加。
MELD-白蛋白评分可为ITVR提供预后价值。此外，MELD-白蛋白评分在ITVR术前对三尖瓣反流（TR）患者的风险分层和患者选择中具有重要作用。
