Skip to main content
Erschienen in: Heart and Vessels 4/2023

23.11.2022 | Original Article

Implication of modified MELD scores for postdischarge prognosis in hospitalized patients with heart failure

verfasst von: Masayuki Gotou, Atsushi Suzuki, Tsuyoshi Shiga, Noriko Kikuchi, Nobuhisa Hagiwara

Erschienen in: Heart and Vessels | Ausgabe 4/2023

Einloggen, um Zugang zu erhalten

Abstract

We evaluated whether modified Model for End-Stage Liver Disease (MELD) scores are useful for predicting the postdischarge prognosis in hospitalized patients with heart failure (HF) who are discharged alive. The MELD-XI and MELD-Na scores were calculated at discharge for a total of 1156 patients in the HIJ-HF II study. We also studied 3 groups on the basis of the left ventricular ejection fraction (LVEF): the HFrEF (LVEF < 40%), HFmrEF (LVEF 40–49%) and HFpEF (LVEF ≥ 50%) groups. The primary outcome was all-cause mortality, and the secondary outcome was rehospitalization due to worsening HF. The median MELD-XI and MELD-Na scores were 12 and 14, respectively. After a median follow-up of 19 months, there were significantly higher rates of all-cause mortality in patients with MELD-XI scores ≥ 12 than in those with MELD-XI scores < 12; there were also higher rates of all-cause mortality in patients with MELD-Na scores ≥ 14 than in those with MELD-Na scores < 14 (both log-rank p < 0.001). The cumulative incidence function based on a competing risks model showed a higher rate of rehospitalization due to worsening HF in patients with MELD-XI scores ≥ 12 than in those with MELD-XI scores < 12 and a higher rate of rehospitalization due to worsening HF in those with MELD-Na scores ≥ 14 than in those with MELD-Na scores < 14 (both Gray’s test p < 0.001). The adjusted hazard ratios (HRs) of all-cause mortality for patients with MELD-XI scores ≥ 12 and those with MELD-Na scores ≥ 14 were 2.07 [95% confidence interval (CI) 1.25–3.44] and 2.79 [95% CI 1.63–4.79], respectively, in the HFrEF group; however, the HRs were not significant in the HFmrEF or HFpEF groups. Thus, MELD-XI and MELD-Na scores may be useful for predicting prognosis in hospitalized HF patients who are discharged alive, especially for those in the HFrEF group.
Anhänge
Nur mit Berechtigung zugänglich
Literatur
2.
Zurück zum Zitat Xanthopoulos A, Starling RC, Kitai T, Triposkiadis F (2019) Heart failure and liver disease: cardiohepatic interactions. JACC Heart Fail 7:87–97CrossRefPubMed Xanthopoulos A, Starling RC, Kitai T, Triposkiadis F (2019) Heart failure and liver disease: cardiohepatic interactions. JACC Heart Fail 7:87–97CrossRefPubMed
3.
Zurück zum Zitat Kamath PS, Wiesner RH, Malinchoc M, Kremers W, Therneau TM, Kosberg CL, D’Amico G, Dickson ER, Kim WR (2001) A model to predict survival in patients with end-stage liver disease. Hepatology 33:464–470CrossRefPubMed Kamath PS, Wiesner RH, Malinchoc M, Kremers W, Therneau TM, Kosberg CL, D’Amico G, Dickson ER, Kim WR (2001) A model to predict survival in patients with end-stage liver disease. Hepatology 33:464–470CrossRefPubMed
4.
Zurück zum Zitat Kamath PS, Kim WR (2007) The model for end-stage liver disease (MELD). Hepatology 45:797–805CrossRefPubMed Kamath PS, Kim WR (2007) The model for end-stage liver disease (MELD). Hepatology 45:797–805CrossRefPubMed
5.
Zurück zum Zitat Matthews JC, Pagani FD, Haft JW, Koelling TM, Naftel DC, Aaronson KD (2010) Model for end-stage liver disease score predicts left ventricular assist device operative transfusion requirements, morbidity, and mortality. Circulation 121:214–220CrossRefPubMedPubMedCentral Matthews JC, Pagani FD, Haft JW, Koelling TM, Naftel DC, Aaronson KD (2010) Model for end-stage liver disease score predicts left ventricular assist device operative transfusion requirements, morbidity, and mortality. Circulation 121:214–220CrossRefPubMedPubMedCentral
6.
Zurück zum Zitat Yang JA, Kato TS, Shulman BP, Takayama H, Farr M, Jorde UP, Mancini DM, Naka Y, Schulze PC (2012) Liver dysfunction as a predictor of outcomes in patients with advanced heart failure requiring ventricular assist device support: use of the model of endstage liver disease (MELD) and MELD eXcluding INR (MELD-XI) scoring system. J Heart Lung Transplant 31:601–610CrossRefPubMedPubMedCentral Yang JA, Kato TS, Shulman BP, Takayama H, Farr M, Jorde UP, Mancini DM, Naka Y, Schulze PC (2012) Liver dysfunction as a predictor of outcomes in patients with advanced heart failure requiring ventricular assist device support: use of the model of endstage liver disease (MELD) and MELD eXcluding INR (MELD-XI) scoring system. J Heart Lung Transplant 31:601–610CrossRefPubMedPubMedCentral
7.
Zurück zum Zitat Kim MS, Kato TS, Farr M, Wu C, Givens RC, Collado E, Mancini DM, Schulze PC (2013) Hepatic dysfunction in ambulatory patients with heart failure: application of the MELD scoring system for outcome prediction. J Am Coll Cardiol 61:2253–2261CrossRefPubMedPubMedCentral Kim MS, Kato TS, Farr M, Wu C, Givens RC, Collado E, Mancini DM, Schulze PC (2013) Hepatic dysfunction in ambulatory patients with heart failure: application of the MELD scoring system for outcome prediction. J Am Coll Cardiol 61:2253–2261CrossRefPubMedPubMedCentral
8.
Zurück zum Zitat Biegus J, Zymlinski R, Sokolski M, Siwolowski P, Gajewski P, Nawrocka-Millward S, Poniewierka E, Jankowska EA, Banasiak W, Ponikowski P (2016) Impaired hepato-renal function defined by the MELD XI score as prognosticator in acute heart failure. Eur J Heart Fail 18:1518–1521CrossRefPubMed Biegus J, Zymlinski R, Sokolski M, Siwolowski P, Gajewski P, Nawrocka-Millward S, Poniewierka E, Jankowska EA, Banasiak W, Ponikowski P (2016) Impaired hepato-renal function defined by the MELD XI score as prognosticator in acute heart failure. Eur J Heart Fail 18:1518–1521CrossRefPubMed
9.
Zurück zum Zitat Grodin JL, Gallup D, Anstrom KJ, Felker GM, Chen HH, Tang WHW (2017) Implications of alternative hepatorenal prognostic scoring systems in acute heart failure (from DOSE-AHF and ROSE-AHF). Am J Cardiol 119:2003–2009CrossRefPubMedPubMedCentral Grodin JL, Gallup D, Anstrom KJ, Felker GM, Chen HH, Tang WHW (2017) Implications of alternative hepatorenal prognostic scoring systems in acute heart failure (from DOSE-AHF and ROSE-AHF). Am J Cardiol 119:2003–2009CrossRefPubMedPubMedCentral
10.
Zurück zum Zitat Biegus J, Demissei B, Postmus D, Cotter G, Davison BA, Felker GM, Filippatos G, Gimpelewicz C, Greenberg B, Metra M, Severin T, Teerlink JR, Voors AA, Ponikowski P (2019) Hepatorenal dysfunction identifies high-risk patients with acute heart failure: insights from the RELAX-AHF trial. ESC Heart Fail 6:1188–1198CrossRefPubMedPubMedCentral Biegus J, Demissei B, Postmus D, Cotter G, Davison BA, Felker GM, Filippatos G, Gimpelewicz C, Greenberg B, Metra M, Severin T, Teerlink JR, Voors AA, Ponikowski P (2019) Hepatorenal dysfunction identifies high-risk patients with acute heart failure: insights from the RELAX-AHF trial. ESC Heart Fail 6:1188–1198CrossRefPubMedPubMedCentral
11.
Zurück zum Zitat McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, Burri H, Butler J, Čelutkienė J, Chioncel O, Cleland JGF, Coats AJS, Crespo-Leiro MG, Farmakis D, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam CSP, Lyon AR, McMurray JJV, Mebazaa A, Mindham R, Muneretto C, Francesco Piepoli M, Price S, Rosano GMC, Ruschitzka F, Kathrine Skibelund A, ESC Scientific Document Group (2021) 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 42:3599–3726CrossRefPubMed McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, Burri H, Butler J, Čelutkienė J, Chioncel O, Cleland JGF, Coats AJS, Crespo-Leiro MG, Farmakis D, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam CSP, Lyon AR, McMurray JJV, Mebazaa A, Mindham R, Muneretto C, Francesco Piepoli M, Price S, Rosano GMC, Ruschitzka F, Kathrine Skibelund A, ESC Scientific Document Group (2021) 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 42:3599–3726CrossRefPubMed
12.
Zurück zum Zitat Shiga T, Suzuki A, Haruta S, Mori F, Ota Y, Yagi M, Oka T, Tanaka H, Murasaki S, Yamauchi T, Katoh J, Hattori H, Kikuchi N, Watanabe E, Yamada Y, Haruki S, Kogure T, Suzuki T, Uetsuka Y, Hagiwara N, HIJ-HFII Investigators (2019) Clinical characteristics of hospitalized heart failure patients with preserved, mid-range, and reduced ejection fractions in Japan. ESC Heart Fail 6:475–486CrossRefPubMedPubMedCentral Shiga T, Suzuki A, Haruta S, Mori F, Ota Y, Yagi M, Oka T, Tanaka H, Murasaki S, Yamauchi T, Katoh J, Hattori H, Kikuchi N, Watanabe E, Yamada Y, Haruki S, Kogure T, Suzuki T, Uetsuka Y, Hagiwara N, HIJ-HFII Investigators (2019) Clinical characteristics of hospitalized heart failure patients with preserved, mid-range, and reduced ejection fractions in Japan. ESC Heart Fail 6:475–486CrossRefPubMedPubMedCentral
13.
Zurück zum Zitat Heuman DM, Mihas AA, Habib A, Gilles HS, Stravitz RT, Sanyal AJ, Fisher RA (2007) MELD-XI: a rational approach to “sickest first” liver transplantation in cirrhotic patients requiring anticoagulant therapy. Liver Transpl 13:30–37CrossRefPubMed Heuman DM, Mihas AA, Habib A, Gilles HS, Stravitz RT, Sanyal AJ, Fisher RA (2007) MELD-XI: a rational approach to “sickest first” liver transplantation in cirrhotic patients requiring anticoagulant therapy. Liver Transpl 13:30–37CrossRefPubMed
14.
Zurück zum Zitat Bettari L, Fiuzat M, Felker GM, O’Connor CM (2012) Significance of hyponatremia in heart failure. Heart Fail Rev 17:17–26CrossRefPubMed Bettari L, Fiuzat M, Felker GM, O’Connor CM (2012) Significance of hyponatremia in heart failure. Heart Fail Rev 17:17–26CrossRefPubMed
15.
Zurück zum Zitat Kim WR, Biggins SW, Kremers WK, Wiesner RH, Kamath PS, Benson JT, Edwards E, Therneau TM (2008) Hyponatremia and mortality among patients on the liver-transplant waiting list. N Engl J Med 359:1018–1026CrossRefPubMedPubMedCentral Kim WR, Biggins SW, Kremers WK, Wiesner RH, Kamath PS, Benson JT, Edwards E, Therneau TM (2008) Hyponatremia and mortality among patients on the liver-transplant waiting list. N Engl J Med 359:1018–1026CrossRefPubMedPubMedCentral
16.
Zurück zum Zitat Chioncel O, Collins SP, Greene SJ, Pang PS, Ambrosy AP, Antohi EL, Vaduganathan M, Butler J, Gheorghiade M (2017) Predictors of post-discharge mortality among patients hospitalized for acute heart failure. Card Fail Rev 3:122–129CrossRefPubMedPubMedCentral Chioncel O, Collins SP, Greene SJ, Pang PS, Ambrosy AP, Antohi EL, Vaduganathan M, Butler J, Gheorghiade M (2017) Predictors of post-discharge mortality among patients hospitalized for acute heart failure. Card Fail Rev 3:122–129CrossRefPubMedPubMedCentral
17.
Zurück zum Zitat Shinagawa H, Inomata T, Koitabashi T, Nakano H, Takeuchi I, Naruke T, Ohsaka T, Nishii M, Takehana H, Izumi T (2008) Prognostic significance of increased serum bilirubin levels coincident with cardiac decompensation in chronic heart failure. Circ J 72:364–369CrossRefPubMed Shinagawa H, Inomata T, Koitabashi T, Nakano H, Takeuchi I, Naruke T, Ohsaka T, Nishii M, Takehana H, Izumi T (2008) Prognostic significance of increased serum bilirubin levels coincident with cardiac decompensation in chronic heart failure. Circ J 72:364–369CrossRefPubMed
18.
Zurück zum Zitat Ambrosy AP, Vaduganathan M, Huffman MD, Khan S, Kwasny MJ, Fought AJ, Maggioni AP, Swedberg K, Konstam MA, Zannad F, Gheorghiade M, EVEREST Trial Investigators (2012) Clinical course and predictive value of liver function tests in patients hospitalized for worsening heart failure with reduced ejection fraction: an analysis of the EVEREST trial. Eur J Heart Fail 14:302–311CrossRefPubMed Ambrosy AP, Vaduganathan M, Huffman MD, Khan S, Kwasny MJ, Fought AJ, Maggioni AP, Swedberg K, Konstam MA, Zannad F, Gheorghiade M, EVEREST Trial Investigators (2012) Clinical course and predictive value of liver function tests in patients hospitalized for worsening heart failure with reduced ejection fraction: an analysis of the EVEREST trial. Eur J Heart Fail 14:302–311CrossRefPubMed
19.
Zurück zum Zitat Samsky MD, Dunning A, DeVore AD, Schulte PJ, Starling RC, Tang WH, Armstrong PW, Ezekowitz JA, Butler J, McMurray JJ, Teerlink JR, Voors AA, Metra M, Mentz RJ, O’Connor CM, Patel CB, Hernandez AF (2016) Liver function tests in patients with acute heart failure and associated outcomes: insights from ASCEND-HF. Eur J Heart Fail 18:424–432CrossRefPubMed Samsky MD, Dunning A, DeVore AD, Schulte PJ, Starling RC, Tang WH, Armstrong PW, Ezekowitz JA, Butler J, McMurray JJ, Teerlink JR, Voors AA, Metra M, Mentz RJ, O’Connor CM, Patel CB, Hernandez AF (2016) Liver function tests in patients with acute heart failure and associated outcomes: insights from ASCEND-HF. Eur J Heart Fail 18:424–432CrossRefPubMed
20.
Zurück zum Zitat Hillege HL, Girbes AR, de Kam PJ, Boomsma F, de Zeeuw D, Charlesworth A, Hampton JR, van Veldhuisen DJ (2000) Renal function, neurohormonal activation, and survival in patients with chronic heart failure. Circulation 102:203–210CrossRefPubMed Hillege HL, Girbes AR, de Kam PJ, Boomsma F, de Zeeuw D, Charlesworth A, Hampton JR, van Veldhuisen DJ (2000) Renal function, neurohormonal activation, and survival in patients with chronic heart failure. Circulation 102:203–210CrossRefPubMed
21.
Zurück zum Zitat Metra M, Cotter G, Gheorghiade M, Dei Cas L, Voors AA (2012) The role of the kidney in heart failure. Eur Heart J 33:2135–2142CrossRefPubMed Metra M, Cotter G, Gheorghiade M, Dei Cas L, Voors AA (2012) The role of the kidney in heart failure. Eur Heart J 33:2135–2142CrossRefPubMed
22.
Zurück zum Zitat Gheorghiade M, Abraham WT, Albert NM, Gattis Stough W, Greenberg BH, O’Connor CM, She L, Yancy CW, Young J, Fonarow GC, OPTIMIZE-HF Investigators and Coordinators (2007) Relationship between admission serum sodium concentration and clinical outcomes in patients hospitalized for heart failure: an analysis from the OPTIMIZE-HF registry. Eur Heart J 28:980–988CrossRefPubMed Gheorghiade M, Abraham WT, Albert NM, Gattis Stough W, Greenberg BH, O’Connor CM, She L, Yancy CW, Young J, Fonarow GC, OPTIMIZE-HF Investigators and Coordinators (2007) Relationship between admission serum sodium concentration and clinical outcomes in patients hospitalized for heart failure: an analysis from the OPTIMIZE-HF registry. Eur Heart J 28:980–988CrossRefPubMed
23.
Zurück zum Zitat Lee SE, Choi DJ, Yoon CH, Oh IY, Jeon ES, Kim JJ, Cho MC, Chae SC, Ryu KH, Oh BH, Registry KorHF (2012) Improvement of hyponatraemia during hospitalisation for acute heart failure is not associated with improvement of prognosis: an analysis from the Korean Heart Failure (KorHF) registry. Heart 98:1798–1804CrossRefPubMed Lee SE, Choi DJ, Yoon CH, Oh IY, Jeon ES, Kim JJ, Cho MC, Chae SC, Ryu KH, Oh BH, Registry KorHF (2012) Improvement of hyponatraemia during hospitalisation for acute heart failure is not associated with improvement of prognosis: an analysis from the Korean Heart Failure (KorHF) registry. Heart 98:1798–1804CrossRefPubMed
24.
Zurück zum Zitat Levy WC, Mozaffarian D, Linker DT, Sutradhar SC, Anker SD, Cropp AB, Anand I, Maggioni A, Burton P, Sullivan MD, Pitt B, Poole-Wilson PA, Mann DL, Packer M (2006) The Seattle Heart Failure Model: prediction of survival in heart failure. Circulation 113:1424–1433CrossRefPubMed Levy WC, Mozaffarian D, Linker DT, Sutradhar SC, Anker SD, Cropp AB, Anand I, Maggioni A, Burton P, Sullivan MD, Pitt B, Poole-Wilson PA, Mann DL, Packer M (2006) The Seattle Heart Failure Model: prediction of survival in heart failure. Circulation 113:1424–1433CrossRefPubMed
25.
Zurück zum Zitat Shiraishi Y, Kohsaka S, Nagai T, Goda A, Mizuno A, Nagatomo Y, Sujino Y, Fukuoka R, Sawano M, Kohno T, Fukuda K, Anzai T, Shadman R, Dardas T, Levy WC, Yoshikawa T (2019) Validation and recalibration of Seattle heart failure model in Japanese acute heart failure patients. J Card Fail 25:561–567CrossRefPubMed Shiraishi Y, Kohsaka S, Nagai T, Goda A, Mizuno A, Nagatomo Y, Sujino Y, Fukuoka R, Sawano M, Kohno T, Fukuda K, Anzai T, Shadman R, Dardas T, Levy WC, Yoshikawa T (2019) Validation and recalibration of Seattle heart failure model in Japanese acute heart failure patients. J Card Fail 25:561–567CrossRefPubMed
26.
Zurück zum Zitat Pocock SJ, Ariti CA, McMurray JJ, Maggioni A, Køber L, Squire IB, Swedberg K, Dobson J, Poppe KK, Whalley GA, Doughty RN, Meta-Analysis Global Group in Chronic Heart Failure (2013) Predicting survival in heart failure: a risk score based on 39 372 patients from 30 studies. Eur Heart J 34:1404–1413CrossRefPubMed Pocock SJ, Ariti CA, McMurray JJ, Maggioni A, Køber L, Squire IB, Swedberg K, Dobson J, Poppe KK, Whalley GA, Doughty RN, Meta-Analysis Global Group in Chronic Heart Failure (2013) Predicting survival in heart failure: a risk score based on 39 372 patients from 30 studies. Eur Heart J 34:1404–1413CrossRefPubMed
27.
Zurück zum Zitat Kitagawa T, Hidaka T, Watanabe N, Naka M, Yamaguchi M, Kanai K, Isobe M, Kihara Y, Nakano Y, Investigators REAL-HF (2022) Current conditions and significance of outpatient cardiac rehabilitation and home nursing-care services in heart failure patients with mid-range or preserved ejection fraction: post-hoc analysis of the REAL-HF registry. Heart Vessels 37:745–754CrossRefPubMed Kitagawa T, Hidaka T, Watanabe N, Naka M, Yamaguchi M, Kanai K, Isobe M, Kihara Y, Nakano Y, Investigators REAL-HF (2022) Current conditions and significance of outpatient cardiac rehabilitation and home nursing-care services in heart failure patients with mid-range or preserved ejection fraction: post-hoc analysis of the REAL-HF registry. Heart Vessels 37:745–754CrossRefPubMed
28.
Zurück zum Zitat Watanabe Y, Horiuchi Y, Nakase M, Setoguchi N, Ishizawa T, Sekiguchi M, Nonaka H, Nakajima M, Asami M, Yahagi K, Komiyama K, Yuzawa H, Tanaka J, Aoki J, Tanabe K (2022) Malnutrition, hemodynamics and inflammation in heart failure with reduced, mildly reduced and preserved ejection fraction. Heart Vessels 37:1841–1849CrossRefPubMed Watanabe Y, Horiuchi Y, Nakase M, Setoguchi N, Ishizawa T, Sekiguchi M, Nonaka H, Nakajima M, Asami M, Yahagi K, Komiyama K, Yuzawa H, Tanaka J, Aoki J, Tanabe K (2022) Malnutrition, hemodynamics and inflammation in heart failure with reduced, mildly reduced and preserved ejection fraction. Heart Vessels 37:1841–1849CrossRefPubMed
Metadaten
Titel
Implication of modified MELD scores for postdischarge prognosis in hospitalized patients with heart failure
verfasst von
Masayuki Gotou
Atsushi Suzuki
Tsuyoshi Shiga
Noriko Kikuchi
Nobuhisa Hagiwara
Publikationsdatum
23.11.2022
Verlag
Springer Japan
Erschienen in
Heart and Vessels / Ausgabe 4/2023
Print ISSN: 0910-8327
Elektronische ISSN: 1615-2573
DOI
https://doi.org/10.1007/s00380-022-02202-z

Weitere Artikel der Ausgabe 4/2023

Heart and Vessels 4/2023 Zur Ausgabe

Update Kardiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.