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Predictive Value of Hepatic and Renal Dysfunction Based on the Models for End-Stage Liver Disease in Patients With Heart Failure Evaluated for Heart Transplant.
- Source :
-
Transplantation proceedings [Transplant Proc] 2016 Jun; Vol. 48 (5), pp. 1756-60. - Publication Year :
- 2016
-
Abstract
- Background: The evaluation of prognosis and determination of a long-term treatment strategy is an important element of management in patients with heart failure (HF).<br />Methods: The aim of the study was to determine the prognostic value of the Model for End-Stage Liver Disease (MELD) and its modifications, MELD and serum sodium (MELD-Na) and MELD excluding the international normalized ratio (MELD-XI), as well as other independent risk factors for death during a 4-year follow-up. We analyzed retrospectively 143 patients with advanced HF, evaluated for heart transplant between 2009 and 2011. Patients using warfarin were excluded from the study. The long-term follow-up data were obtained during follow-up visits and/or phone contact with the patients or their families.<br />Results: The age of the patients was 54 (48-59) years and 88.1% of patients were male. Mortality rate during the follow-up period was 49%. The MELD scores (hazard ratio [HR], 1.12; P < .001), as well as serum high-sensitivity C-reactive protein (hs-CRP; HR, 1.01; P < .01) and N-terminal pro-brain natriuretic peptide (NT-proBNP; HR, 1.01; P < .05) levels, were independent risk factors for death. Receiver operator characteristic analysis indicated that a MELD cutoff of 10 (area under the curve [AUC], 0.756; P < .0001], MELD-XI cutoff of 13.0 (AUC, 0.720; P < .0001), MELD-Na cutoff of 13.0 (AUC, 0.813; P < .0001), hs-CRP cutoff of 4.02 (AUC, 0.686; P < .001), and NT-proBNP cutoff of 1055 (AUC, 0.722; P < .001) were the best predictive values as predictors of death.<br />Conclusions: MELD, MELD-Na, and MELD-XI scores are prognostic factors for death during a 4-year follow-up. A high MELD score is an independent prognostic factor for death. NT-proBNP and hs-CRP serum concentrations are other independent factors influencing death.<br /> (Copyright © 2016 Elsevier Inc. All rights reserved.)
- Subjects :
- Biomarkers blood
C-Reactive Protein metabolism
End Stage Liver Disease complications
Epidemiologic Methods
Female
Heart Failure mortality
Humans
International Normalized Ratio
Male
Middle Aged
Natriuretic Peptide, Brain metabolism
Peptide Fragments metabolism
Prognosis
Renal Insufficiency, Chronic complications
End Stage Liver Disease mortality
Heart Failure surgery
Heart Transplantation mortality
Renal Insufficiency, Chronic mortality
Subjects
Details
- Language :
- English
- ISSN :
- 1873-2623
- Volume :
- 48
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- Transplantation proceedings
- Publication Type :
- Academic Journal
- Accession number :
- 27496486
- Full Text :
- https://doi.org/10.1016/j.transproceed.2016.01.079