Liver dysfunction assessed by model for end-stage liver disease excluding INR (MELD-XI) scoring system predicts adverse prognosis in heart failure.
Liver dysfunction assessed by model for end-stage liver disease excluding INR (MELD-XI) scoring system predicts adverse prognosis in heart failure.
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DOI：
10.1371/journal.pone.0100618
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发表时间：
2014
期刊：
影响因子：
3.7
通讯作者：
Takeishi Y
中科院分区：
文献类型：
--
作者：
Abe S;Yoshihisa A;Takiguchi M;Shimizu T;Nakamura Y;Yamauchi H;Iwaya S;Owada T;Miyata M;Sato T;Suzuki S;Oikawa M;Kobayashi A;Yamaki T;Sugimoto K;Kunii H;Nakazato K;Suzuki H;Saitoh S;Takeishi Y
心力衰竭（HF）引起的肝功能障碍通常被称为心脏病或充血性肝病。不包括 INR 的终末期肝病复合模型 (MELD-XI) 是一个强大的肝功能评分系统，高评分与接受心脏移植和/或心室辅助装置的晚期心力衰竭患者预后不良相关。然而，MELD-XI 对心衰患者预后的影响总体上仍不清楚。我们回顾性分析了 562 例因失代偿性心力衰竭入院的患者。对MELD-XI评分进行分级，根据MELD-XI评分中位数将患者分为两组：L组（MELD-XI<10，n = 289）和H组（MELD-XI≥10，n = 273）。我们比较了两组之间的全因死亡率和超声心动图检查结果。在随访期间（平均 471 天），观察到 104 例死亡（62 例心源性死亡和 42 例非心源性死亡）。 L组的无事件率（心源性死亡、非心源性死亡、全因死亡）显着高于H组（分别对数秩P<0.05）。在 Cox 比例风险分析中，发现高 MELD-XI 评分是心力衰竭患者心源性死亡和全因死亡率的独立预测因子。超声心动图参数方面，H组右心房面积、心室面积、下腔静脉直径、肺动脉收缩压均高于L组（P<0.05）。 MELD-XI 评分系统是肝功能的标志物，可以识别右心容量超负荷、肺动脉压升高以及与心力衰竭相关的多器官衰竭的高危患者。
Liver dysfunction due to heart failure (HF) is often referred to as cardiac or congestive hepatopathy. The composite Model for End-Stage Liver Disease excluding INR (MELD-XI) is a robust scoring system of liver function, and a high score is associated with poor prognosis in advanced HF patients with a heart transplantation and/or ventricular assist device. However, the impact of MELD-XI on the prognosis of HF patients in general remains unclear. We retrospectively analyzed 562 patients who were admitted to our hospital for the treatment of decompensated HF. A MELD-XI score was graded, and patients were divided into two groups based on the median value of MELD-XI score: Group L (MELD-XI <10, n = 289) and Group H (MELD-XI ≥10, n = 273). We compared all-cause mortality and echocardiographic findings between the two groups. In the follow-up period (mean 471 days), 104 deaths (62 cardiac deaths and 42 non-cardiac deaths) were observed. The event (cardiac death, non-cardiac death, all-cause death)-free rate was significantly higher in group L than in group H (logrank P<0.05, respectively). In the Cox proportional hazard analysis, a high MELD-XI score was found to be an independent predictor of cardiac deaths and all-cause mortality in HF patients. Regarding echocardiographic parameters, right atrial and ventricular areas, inferior vena cava diameter, and systolic pulmonary artery pressure were higher in group H than in group L (P<0.05, respectively). The MELD-XI scoring system, a marker of liver function, can identify high-risk patients with right heart volume overload, higher pulmonary arterial pressure and multiple organ failure associated with HF.