Ptak Jakub, Sokolski Mateusz, Gontarczyk Joanna, Mania Roksana, Byszuk Piotr, Krupka Dominik, Makowska Paulina, Cielecka Magdalena, Boluk Anna, Rakowski Mateusz, Wilk Mateusz, Bochenek Maciej, Przybylski Roman, Zakliczyński Michał
Institute of Heart Diseases, Wroclaw Medical University, Poland Borowska 213, 50-556 Wroclaw, Poland.
Clinic of Cardiac Transplantation and Mechanical Circulatory Support, Institute of Heart Diseases, Wroclaw Medical University, 50-556 Wroclaw, Poland.
J Clin Med. 2024 Sep 28;13(19):5816. doi: 10.3390/jcm13195816.
: Multi-organ failure (MOF) often complicates advanced heart failure (HF), contributing to a poor prognosis. The Model of End-Stage Liver Disease 3.0 (MELD-3.0) scale incorporates liver and kidney function parameters. This study aims to evaluate the prognostic significance of the MELD-3.0 score in patients with advanced HF who have undergone heart transplantation (HTx). : The MELD-3.0 score was computed using the average values of the international normalized ratio and bilirubin, creatinine, sodium, and albumin levels during a hospital stay following HTx. The average MELD-3.0 scores from the period of 1 month preceding HTx and 1 week after HTx were analyzed. The primary endpoint of the study was the 6-month total mortality, and the secondary endpoint was ICU hospitalization time after HTx. : The analysis included 106 patients undergoing HTx, with a median age of 53 years (44-63), 81% of whom were male. Within 6 months post-HTx, 17 patients (16%) died; those patients had a higher 1-week post-HTx MELD-3.0 score of 18.3 (14.5-22.7) in comparison to survivors, whose average score was 13.9 (9.5-16.4), < 0.01. There was no difference in MELD 3.0 score in the pre-HTx period: 16.6 (11.4-17.8) vs. 12.3 (8.6-17.1), = 0.36. The post-HTx MELD-3.0 score independently predicted death: RR 1.17 (95% CI 1.05-1.30), < 0.01. A Receiver Operating Characteristic (ROC) determined the cut-off value of the MELD-3.0 score as 17.3 (AUC = 0.83; sensitivity-67%; specificity-86%). Survivors with scores above this value had a longer ICU hospitalization time: 7 (5.0-11.0) vs. 12 (8-20) days ( = 0.01). : The post-HTx MELD-3.0 score serves as an independent predictor of an unfavorable prognosis in patients with advanced HF undergoing HTx. The evaluation of MELD-3.0 scores provides additional prognostic information in this population.
多器官功能衰竭（MOF）常使晚期心力衰竭（HF）复杂化，导致预后不良。终末期肝病模型3.0（MELD-3.0）评分纳入了肝脏和肾脏功能参数。本研究旨在评估MELD-3.0评分在接受心脏移植（HTx）的晚期HF患者中的预后意义。
MELD-3.0评分通过HTx后住院期间国际标准化比值、胆红素、肌酐、钠和白蛋白水平的平均值计算得出。分析了HTx前1个月和HTx后1周期间的平均MELD-3.0评分。研究的主要终点是6个月总死亡率，次要终点是HTx后的重症监护病房（ICU）住院时间。
分析纳入了106例接受HTx的患者，中位年龄53岁（44-63岁），其中81%为男性。HTx后6个月内，17例患者（16%）死亡；与幸存者相比，这些患者HTx后1周的MELD-3.0评分更高，为18.3（14.5-22.7），而幸存者的平均评分为13.9（9.5-16.4），P<0.01。HTx前阶段的MELD 3.0评分无差异：16.6（11.4-17.8）对12.3（8.6-17.1），P=0.36。HTx后的MELD-3.0评分独立预测死亡：风险比1.17（95%可信区间1.05-1.30），P<0.01。受试者工作特征曲线（ROC）确定MELD-3.0评分的截断值为17.3（曲线下面积=0.83；敏感性-67%；特异性-86%）。评分高于此值的幸存者ICU住院时间更长：7（5.0-11.0）天对12（8-20）天（P=0.01）。
HTx后的MELD-3.0评分可作为接受HTx的晚期HF患者预后不良的独立预测指标。对MELD-3.0评分的评估为该人群提供了额外的预后信息。
