Hepatic dysfunction in ambulatory patients with heart failure: application of the MELD scoring system for outcome prediction.
Hepatic dysfunction in ambulatory patients with heart failure: application of the MELD scoring system for outcome prediction.
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DOI：
10.1016/j.jacc.2012.12.056
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发表时间：
2013-06-04
影响因子：
24
通讯作者：
Schulze, P. Christian
中科院分区：
文献类型：
--
作者：
Kim, Margaret S.;Kato, Tomoko S.;Farr, Maryjane;Wu, Christina;Givens, Raymond C.;Collado, Ellias;Mancini, Donna M.;Schulze, P. Christian
本研究评价了终末期肝病模型（MELD）评分及其改良版本，这是肝功能障碍的既定指标，可作为评估非卧床心力衰竭患者心脏移植（HTx）紧迫性的工具。肝脏异常对晚期心力衰竭患者的预后有影响。我们回顾性评价了2005年至2009年期间接受HTx评价的343例患者。在我们的队列和接受和不接受口服抗凝治疗的患者亚组中评价了MELD和2种改良（MELDNa [包括血清钠水平]和MELD-XI [不包括国际标准化比值]）对终点事件（定义为死亡/HTx/心室辅助装置要求）的预后有效性。MELD和MELDNa评分是1年终点事件的极好预测因子（曲线下面积分别为0.71和0.73）。高评分（>12）与1年生存率低密切相关（MELD 69.3% vs. 90.4% [p < 0.0001]; MELDNa 70.4% vs. 96.9% [p < 0.0001]）。评分增加与HTx风险增加相关（风险比：1.10 [95%置信区间：1.06至1.14];两种评分p < 0.0001），这与其他已知风险因素无关（MELD p = 0.0055; MELDNa p = 0.0083）。使用抗凝剂与1年生存率差相关（73.7% vs. 86.4%; p = 0.0118），未接受口服抗凝治疗的患者MELD/MELDNa的统计学显著性更高。MELD-XI是接受口服抗凝治疗患者终点事件的一个公平但有限的预测因子。根据MELD评分系统评估肝功能障碍为非卧床心力衰竭患者提供了额外的风险信息。
This study evaluated the Model for End-Stage Liver Disease (MELD) score and its modified versions, which are established measures of liver dysfunction, as a tool to assess heart transplantation (HTx) urgency in ambulatory patients with heart failure. Liver abnormalities have a prognostic impact on the outcome of patients with advanced heart failure. We retrospectively evaluated 343 patients undergoing HTx evaluation between 2005 and 2009. The prognostic effectiveness of MELD and 2 modifications (MELDNa [includes serum sodium levels] and MELD-XI [does not include international normalized ratio]) for endpoint events, defined as death/HTx/ventricular assist device requirement, was evaluated in our cohort and in subgroups of patients on and off oral anticoagulation. The MELD and MELDNa scores were excellent predictors for 1-year endpoint events (areas under the curve: 0.71 and 0.73, respectively). High scores (>12) were strongly associated with poor survival at 1 year (MELD 69.3% vs. 90.4% [p < 0.0001]; MELDNa 70.4% vs. 96.9% [p < 0.0001]). Increased scores were associated with increased risk for HTx (hazard ratio: 1.10 [95% confidence interval: 1.06 to 1.14]; p < 0.0001 for both scores), which was independent of other known risk factors (MELD p = 0.0055; MELDNa p = 0.0083). Anticoagulant use was associated with poor survival at 1 year (73.7% vs. 86.4%; p = 0.0118), and the statistical significance of MELD/MELDNa was higher in patients not receiving oral anticoagulation therapy. MELD-XI was a fair but limited predictor of the endpoint events in patients receiving oral anticoagulation therapy. Assessment of liver dysfunction according to the MELD scoring system provides additional risk information in ambulatory patients with heart failure.
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影响因子：
4.6
作者：
Heuman, Douglas M.;Mihas, Anastasios A.;Fisher, Robert A.
通讯作者：
Fisher, Robert A.
影响因子：
4.8
作者：
Cleland, JGF;Findlay, I;Poole-Wilson, PA
通讯作者：
Poole-Wilson, PA
DOI：
10.1056/nejmoa1202299
发表时间：
2012-05-17
期刊：
The New England journal of medicine
影响因子：
--
作者：
Homma S;Thompson JL;Pullicino PM;Levin B;Freudenberger RS;Teerlink JR;Ammon SE;Graham S;Sacco RL;Mann DL;Mohr JP;Massie BM;Labovitz AJ;Anker SD;Lok DJ;Ponikowski P;Estol CJ;Lip GY;Di Tullio MR;Sanford AR;Mejia V;Gabriel AP;del Valle ML;Buchsbaum R;WARCEF Investigators
通讯作者：
WARCEF Investigators
影响因子：
37.8
作者：
Klein, L;O'Connor, CM;Gheorghiade, M
通讯作者：
Gheorghiade, M
影响因子：
2.8
作者：
Lund, LH;Aaronson, KD;Mancini, DM
通讯作者：
Mancini, DM