终末期肝病改良模型评分在接受心脏再同步治疗患者中的预后价值。
Prognostic value of the modified Model for End-Stage Liver Disease score in patients treated with cardiac resynchronization therapy.
作者信息
Long Tianxin, Yu Yu, Cheng Sijing, Huang Hao, Hua Wei
机构信息
Cardiac Arrhythmia Center, Department of Cardiology, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
出版信息
Heart Rhythm O2. 2025 Jan 10;6(3):339-349. doi: 10.1016/j.hroo.2024.12.014. eCollection 2025 Mar.
BACKGROUND
Hepatorenal dysfunction is prevalent among individuals with heart failure (HF).
OBJECTIVE
This study investigated prognostic value of the modified Model for End-Stage Liver Disease (Model for End-Stage Liver Disease excluding international normalized ratio [MELD-XI] scores and Model for End-Stage Liver Disease with albumin replacing international normalized ratio [MELD-Albumin]) score in patients undergoing cardiac resynchronization therapy (CRT).
METHODS
We retrospectively evaluated 365 patients (mean age 58.7 ± 11.1 years; 64.9% men) undergoing CRT implantation between 2007 and 2019. Patients were divided into 4 groups based on the modified MELD score quartiles before CRT. The primary endpoint was the combination of all-cause mortality and HF hospitalization, whereas the secondary endpoint was CRT response at 6 months.
RESULTS
During mean follow-up of 3.3 years (interquartile range 1.9-5.2 years), 168 patients reached the primary endpoint. Logistic regression revealed the MELD-Albumin score was independently associated with CRT response, even after adjusting for covariates (odds ratio 1.10; 95% confidence interval [CI] 1.02-1.19; = .013). Kaplan-Meier analysis revealed that patients with a higher MELD-XI and MELD-Albumin score had a greater risk of adverse outcomes (log-rank test: .001). A Cox proportional hazards analysis showed that the modified MELD score remained significantly associated with adverse outcomes after adjusting for clinical and echocardiographic factors (MELD-XI: hazard ratio 1.06, 95% CI 1.02-1.11, .006; MELD-Albumin: hazard ratio 1.10, 95% CI 1.05-1.16, .001). Furthermore, receiver-operating characteristic analysis indicated that the MELD-Albumin score provided a stronger prognostic value for long-term adverse outcomes in patients undergoing CRT than the MELD-XI score (MELD-Albumin: area under the curve 0.692, 95% CI 0.644-0.742; MELD-XI: area under the curve 0.659, 95% CI 0.608-0.715; .008).
CONCLUSION
The MELD-Albumin score may be useful for stratifying patients at risk for CRT response and adverse outcomes in those undergoing CRT for HF.
背景
肝肾功障碍在心力衰竭（HF）患者中很常见。
目的
本研究调查了改良终末期肝病模型（排除国际标准化比值的终末期肝病模型[MELD-XI]评分和用白蛋白替代国际标准化比值的终末期肝病模型[MELD-白蛋白]）评分在接受心脏再同步治疗（CRT）患者中的预后价值。
方法
我们回顾性评估了2007年至2019年间接受CRT植入的365例患者（平均年龄58.7±11.1岁；64.9%为男性）。根据CRT前改良MELD评分四分位数将患者分为4组。主要终点是全因死亡率和HF住院的联合情况，次要终点是6个月时的CRT反应。
结果
在平均3.3年的随访期间（四分位间距1.9 - 5.2年），168例患者达到主要终点。逻辑回归显示，即使在调整协变量后，MELD-白蛋白评分仍与CRT反应独立相关（比值比1.10；95%置信区间[CI]1.02 - 1.19；P = 0.013）。Kaplan-Meier分析显示，MELD-XI和MELD-白蛋白评分较高的患者不良结局风险更大（对数秩检验：P < 0.001）。Cox比例风险分析表明，在调整临床和超声心动图因素后，改良MELD评分仍与不良结局显著相关（MELD-XI：风险比1.06，95% CI 1.02 - 1.11，P = 0.006；MELD-白蛋白：风险比1.10，95% CI 1.05 - 1.16，P = 0.001）。此外，受试者工作特征分析表明，对于接受CRT的患者，MELD-白蛋白评分在预测长期不良结局方面比MELD-XI评分具有更强的预后价值（MELD-白蛋白：曲线下面积0.692，95% CI 0.644 - 0.742；MELD-XI：曲线下面积0.659，95% CI 0.608 - 0.715；P = 0.008）。
结论
MELD-白蛋白评分可能有助于对接受HF的CRT患者中CRT反应风险和不良结局的患者进行分层。
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