The model for end-stage liver disease excluding international normalized ratio (MELD-XI) predicts three-year mortality in patients with advanced heart failure

Abstract

Introduction: Accurate risk stratification is an important element of management in patients with advanced heart failure (adHF). Objectives: We aimed to determine factors associated with three–year mortality in patients with adHF who underwent qualification for heart transplantation. Material and methods: We retrospectively analyzed the data of 417 consecutive adult patients with adHF hospitalized in the Cardiology Department between 2011 and 2017. We included patients with New York Heart Association classes III–IV with at least two episodes of proven congestion requiring high-dose intravenous diuretics in the last 12 months. Exclusion criteria were acute HF, inotropic support, any previous heart surgery, inflammatory diseases, chronic kidney and liver disease, severe obstructive pulmonary disease and hematologic, autoimmune or neoplastic diseases. We analysed prognostic value of the model for end-stage liver disease (MELD), which reflects multiorgan dysfunction. The primary endpoint was death during three years of follow-up. Results: In the overall population of 293 patients the median age was 56 (51–61) years, and 92.8% of the patients were male. During the follow-up period, 160 patients reached the primary endpoint. The MELD-XI score hazard ratio (HR) 1.197; 95% CI (confidence interval) (1.131–1.267), p < 0.001), PLR value [HR 1.100; 95% CI (1.080–1.130), p < 0.001], uric acid [HR 1.013; 95% CI (1.002–1.024), p = 0.0169] and sodium HR 1.079; 95% CI (1.044–1.115), p < 0.001] serum concentrations were independent factors of three–year mortality. Conclusions: Higher MELD-XI scores and PLR values as well as higher uric acid and lower serum sodium concentrations are associated with worse outcomes in patients with adHF.