Key result
A high MELD-XI score independently predicted major adverse cardiac events in patients with adult congenital heart disease.
Why the study?
Patients with adult congenital heart disease face increased risk of late cardiovascular complications, but predictive factors for long-term outcomes are poorly understood and the prognostic value of the MELD-XI score in this population was unknown.
Does a high MELD-XI score predict major adverse cardiac events in patients with adult congenital heart disease?
Cohort (n=637)
No
Does a high MELD-XI score predict major adverse cardiac events in patients with adult congenital heart disease?
The MELD-XI score is a significant independent predictor of major adverse cardiac events in patients with adult congenital heart disease, suggesting its utility for long-term risk stratification.
Answers are grounded in this paper and cite their sources.
May aid risk stratification in adult congenital heart disease; leaves open prospective validation before clinical use.
Patients with adult congenital heart disease (ACHD) are at increased risk of developing late cardiovascular complication. However, little is known about the predictive factors for long-term outcome. The Model for End-Stage Liver Disease eXcluding INR (MELD-XI) score was originally developed to assess cirrhotic patients and has the prognostic value for heart failure (HF) patients. In the present study, we examined whether the score also has the prognostic value in this population. We retrospectively examined 637 ACHD patients (mean age 31.0 years) who visited our Tohoku University hospital from 1995 to 2015. MELD-XI score was calculated as follows; 11.76 x ln(serum creatinine) + 5.11 x ln(serum total bilirubin) + 9.44. We compared the long-term outcomes between the high (≥10.4) and the low (<10.4) score groups. The cutoff value of MELD-XI score was determined based on the survival classification and regression tree (CART) analysis. The major adverse cardiac event (MACE) was defined as a composite of cardiac death, HF hospitalization, and lethal ventricular arrhythmias. During a mean follow-up period of 8.6 years (interquartile range 4.4-11.4 years), MACE was noted in 51 patients, including HF hospitalization in 37, cardiac death in 8, and lethal ventricular arrhythmias in 6. In Kaplan-Meier analysis, the high score group had significantly worse MACE-free survival compared with the low score group (log-rank, P<0.001). Multivariable Cox regression analysis showed that the MELD-XI score remained a significant predictor of MACE (hazard ratio 1.36, confidence interval 1.17-1.58, P<0.001) even after adjusting for patient characteristics, such as sex, functional status, estimated glomerular filtration rate, and cardiac function. Furthermore, CART analysis revealed that the MELD-XI score was the most important variable for predicting MACE. These results demonstrate that the MELD-XI score can effectively predict MACE in ACHD patients, indicating that ACHD patients with high MELD-XI score need to be closely followed.
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Konno et al. (2019) conducted a cohort in Adult congenital heart disease (n=637). High MELD-XI score (≥10.4) vs. Low MELD-XI score (<10.4) was evaluated on Major adverse cardiac event (MACE), a composite of cardiac death, heart failure hospitalization, and lethal ventricular arrhythmias (HR 1.36, 95% CI 1.17-1.58, p=<0.001). A high MELD-XI score independently predicted major adverse cardiac events in patients with adult congenital heart disease.
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