MELD-XI Score in Hospitalized Heart Failure Patients with Cardiac Electronic Devices

  • Orçun Çiftci Başkent University Faculty of Medicine, Department of Cardiology
  • Caşit Olgun Çelik Başkent University Faculty of Medicine
  • Kerem Can Yılmaz Başkent University Faculty of Medicine
  • Emir Karaçağlar Başkent University Faculty of Medicine
  • Burak Sezenöz Gazi University Faculty of Medicine
  • Bülent Özin Başkent University Faculty of Medicine
  • İbrahim Haldun Müderrisoğlu Başkent University Faculty of Medicine

Abstract

Objective: MELD-XI (Model for End-Stage Liver Disease Excluding INR) score predicts mortality in patients with heart failure. Herein, we assessed the role of MELD-XI score in predicting in-hospital mortality among heart failure patients having intracardiac cardioverter defibrillator  (ICD) or cardiac resynchronization therapy with defibrillator backup (CRT-D) who presented with appropriate device shock or acute decompensated heart failure. Methods: We reviewed the medical records of patients with implantable cardioverter defibrillator or cardiac resynchronization therapy with defibrillator backup admitted to coronary care unit with acute decompensated heart failure or appropriate implantable device shocks between 01 January 2013 and 01 November 2018. MELD-XI score was compared between the deceased and surviving patients. The correlation of MELD-XI score with in-hospital mortality was sought. Results: There were 106 coronary care unit admissions of 67 patients (52 (77.6%) males and 15 (22.4%) females), who had a mean age of 64.8 (range 19-93) years. Eighty-eight (83.0%) admissions were for acute decompensated heart failure and 18 (17.0%) for appropriate device shock and/or electrical storm. A total of 16 (15.1%) patients died at hospital. The median MELD-XI score of the patients who died at hospital was significantly greater than that of the survivors (11.80 (0.59-28.98) vs 15.24 (9.11-24.64); p<0.05). A binary logistic regression analysis showed that MELD-XI score was a significant independent predictor of in-hospital mortality (X2=1.229 (%95 CI 1.06-1.43); p<0.05). Conclusion: MELD-XI score successfully predicts in-hospital mortality among patients with ICD or CRT-D admitted with acute decompensated heart failure or appropriate implantable electronic device shocks.

Author Biographies

Orçun Çiftci, Başkent University Faculty of Medicine, Department of Cardiology
Assist. Prof. Dr, Department of Cardiology
Caşit Olgun Çelik, Başkent University Faculty of Medicine
Department of Cardiology, MD
Kerem Can Yılmaz, Başkent University Faculty of Medicine
Department of Cardiology, Assist.Prof.Dr.
Emir Karaçağlar, Başkent University Faculty of Medicine
Department of Cardiology, Assist.Prof.Dr.
Burak Sezenöz, Gazi University Faculty of Medicine
Department of Cardiology, Assist.Prof.Dr
Bülent Özin, Başkent University Faculty of Medicine
Department of Cardiology, Prof.Dr
İbrahim Haldun Müderrisoğlu, Başkent University Faculty of Medicine
Department of Cardiology, Prof.Dr

References

Roth C, Schrutka L, Binder C, Kriechbaumer L, Heinz G, Lang IM, et al. Liver function predicts survival in patients undergoing extracorporeal membrane oxygenation following cardiovascular surgery. Crit Care. 2016;20(1):57

Jung C, Kelm M, Westenfeld R. Liver function during mechanical circulatory support: from witness to prognostic determinant. Crit Care. 2016;20(1):134 doi: 10.1186/s13054-016-1312-7

Jung C, Lauten A, Ferrari M. Microcirculation in cardiogenic shock: from scientific bystander to therapy target. Crit Care. 2010;14(5):193 doi: 10.1186/cc9244.

Cruz DN. Cardiorenal Syndrome in Critical Care: The Acute Cardiorenal and Renocardiac Syndromes. Advances in Chronic Kidney Disease. Adv Chronic Kidney Dis. 2013 Jan;20(1):56-66. doi: 10.1053/j.ackd.2012.10.005.

Samsky MD, Patel CB, DeWald TA, Smith AD, Felker GM, Rogers JG, Hernandez AF. Cardiohepatic interactions in heart failure: an overview and clinical implications. J Am Coll Cardiol. 2013 18;61:2397-2405. doi: 10.1016/j.jacc.2013.03.042. Epub 2013 Apr 17.

Giallourakis CC, Rosenberg PM, Friedman LS. The liver in heart failure. Clin Liver Dis. 2002;6(4):947–67, viii–ix.

Cholongitas E, Marelli L, Shusang V, Senzolo M, Rolles K, Patch D, et al. A systematic review of the performance of the model for end-stage liver disease (MELD) in the setting of liver transplantation. Liver Transpl. 2006;12(7):1049–61. doi: 10.1002/lt.20824.

McCaughan GW, Crawford M, Sandroussi C, Koorey DJ, Bowen DG, Shackel NA, et al. Assessment of adult patients with chronic liver failure for liver transplantation in 2015: who and when? Intern Med J. 2016;46(4):404–12. doi: 10.1111/imj.13025.

Kamath PS, Kim WR, Advanced Liver Disease Study G. The model for end-stage liver disease (MELD). Hepatology. 2007;45(3):797–805. doi: 10.1002/hep.21563.

Kim MS, Kato TS, Farr M, et al. Hepatic dysfunction in ambulatory patients with heart failure: application of the MELD scoring system for outcome prediction. J Am Coll Cardiol 2013;61:2253–61.

Dichtl W, Vogel W, Dunst KM, et al. Cardiac hepatopathy before and after heart transplantation. Transpl Int 2005;18: 697–702.

Matthews JC, Pagani FD, Haft JW, et al. Model for end-stage liver disease score predicts left ventricular assist device operative transfusion requirements, morbidity, and mortality. Circulation 2010;121:214–20.

Wernly B, Lichtenauer M, Franz M, et al. Model for End-stage Liver Disease excluding INR (MELD-XI) score in critically ill patients: Easily available and of prognostic relevance. PLoS One. 2017;12(2):e0170987. Published 2017 Feb 2. doi:10.1371/journal.pone.0170987.

Heuman DM, Mihas AA, Habib A, et al. MELD-XI: a rational approach to “sickest first” liver transplantation in cirrhotic patients requiring anticoagulant therapy. Liver Transpl 2007;13:30–7.

Spieker M, Hellhammer K, Wiora J, Klose S, Zeus T, Jung C, Saeed D, Horn P, Kelm M, Westenfeld R. Prognostic value of impaired hepato-renal function assessed by the MELD-XI score in patientsundergoing percutaneous mitral valve repair. Catheter Cardiovasc Interv. 2018 Oct 17. doi: 10.1002/ccd.27906. [Epub ahead of print].

Critsinelis A, Kurihara C, Volkovicher N, Kawabori M, Sugiura T, Manon M 2nd, Wang S, Civitello AB, Morgan JA. Model of End-Stage Liver Disease-eXcluding International Normalized Ratio (MELD-XI) Scoring System to Predict Outcomes in Patients Who Undergo Left Ventricular Assist Device Implantation. Ann Thorac Surg. 2018 Aug;106(2):513-519. doi: 10.1016/j.athoracsur.2018.02.082. Epub 2018 Apr 4.

He PC, Wei XB, Luo SN, Chen XL, Ke ZH, Yu DQ, Chen JY, Liu YH, Tan N.Risk prediction in infective endocarditis by modified MELD-XI score. Eur J Clin Microbiol Infect Dis. 2018 Jul;37(7):1243-1250. doi: 10.1007/s10096-018-3240-8. Epub 2018 Mar 29.

Metra M., Davison B., Bettari L., et al: Is worsening renal function an ominous prognostic sign in patients with acute heart failure? The role of congestion and its interaction with renal function. Circ Heart Fail 2012; 5: pp. 54-62.

Chokshi A, Cheema FH, Schaefle KJ, Jiang J, Collado E, Shahzad K, Khawaja T, Farr M, Takayama H, Naka Y, Mancini DM, Schulze PC J. Hepatic dysfunction and survival after orthotopic heart transplantation: application of the MELD scoring system for outcome prediction. Heart Lung Transplant. 2012 Jun; 31(6):591-600.

Yang JA, Kato TS, Shulman BP, Takayama H, Farr M, Jorde UP. Liver dysfunction as a predictor of outcomes in patients with advanced heart failure requiring ventricular assist device support Use of the Model of End-stage Liver Disease (MELD) and MELD eXcluding INR (MELD-XI) scoring system. J Heart Lung Transplant. 2012;31(6):601–610.

Murata M, Kato TS, Kuwaki K, Yamamoto T, Dohi S, Amano A. Preoperative hepatic dysfunction could predict postoperative mortality and morbidity in patients undergoing cardiac surgery: Utilization of the MELD scoring system. Int J Cardiol. 2016 Jan 15; 203():682-9.

Abe S, Yoshihisa A, Takiguchi M, Shimizu T, Nakamura Y, Yamauchi H. Liver Dysfunction Assessed by Model for End-Stage Liver Disease Excluding INR (MELD-XI) Scoring System Predicts Adverse Prognosis in Heart Failure. PLoS One Jun. 2014;9(6):e100618.

Assenza GE, Graham DA, Landzberg MJ, Valente AM, Singh MN, Bashir A. MELD-XI score and cardiac mortality or transplantation in patients after Fontan surgery. Heart Apr. 2013;99(7):491–496.

He PC, Wei XB, Luo SN, Chen XL, Ke ZH, Yu DQ, Chen JY, Liu YH, Tan N. Risk prediction in infective endocarditis by modified MELD-XI score. Eur J Clin Microbiol Infect Dis. 2018 Jul;37(7):1243-1250. doi: 10.1007/s10096-018-3240-8. Epub 2018 Mar 29.

Kim MS, Kato TS, Farr M, et al. Hepatic dysfunction in ambulatory patients with heart failure: application of the MELD scoring system for outcome prediction. J Am Coll Cardiol 2013;61:2253–61.

Grimm, Joshua C. et al. Modified Model for End-Stage Liver Disease eXcluding INR (MELD-XI) Score Predicts Early Death After Pediatric Heart Transplantation. Ann Thorac Sur;2016:101: 730 – 735.

Wernly B, Lichtenauer M, Vellinga N, Boerma C, Ince C, Kelm M, Jung C. Model for End-Stage Liver Disease Excluding INR (MELD-XI) score is associated with hemodynamic impairment and predicts mortality in critically ill patients. Eur J Intern Med. 2018;51:80-84. doi: 10.1016/j.ejim.2018.01.028. Epub 2018 Mar 21.

Published
2019-09-21
Section
Original Research