Key result
MELD-XI and MELD-Albumin scores provided incremental prognostic value for 2-year all-cause mortality over models without hepatorenal indexes (MELD-XI NRI 0.237; 95% CI 0.138-0.323).
Why the study?
Tricuspid regurgitation can damage liver and kidney function, but the prognostic value of MELD-XI and MELD-Albumin scores for predicting mortality in patients with significant TR needed evaluation.
Do modified MELD scores (MELD-XI and MELD-Albumin) predict 2-year mortality in patients with significant tricuspid regurgitation?
Cohort (n=1,825)
Do modified MELD scores (MELD-XI and MELD-Albumin) predict 2-year mortality in patients with significant tricuspid regurgitation?
Effect estimate: NRI 0.237 (95% CI 0.138-0.323)
p-value: p=< 0.001
Modified MELD scores (MELD-XI and MELD-Albumin) provide incremental prognostic information for predicting 2-year mortality in patients with significant tricuspid regurgitation.
Higher MELD-XI and MELD-Albumin scores were associated with 2-year mortality in significant TR; leaves open whether they enhance risk stratification beyond established models.
AIMS: Tricuspid regurgitation (TR) may cause damage to liver and kidney function. The Model for End-Stage Liver Disease excluding international normalized ratio (MELD-XI) and the model with albumin replacing international normalized ratio (MELD-Albumin) scores, which include both liver and kidney function indexes, may predict mortality in patients with TR. The study aimed to analyse the prognostic value of MELD-XI and MELD-Albumin scores in patients with significant TR. METHODS AND RESULTS: A total of 1825 patients with at least moderate pure native TR from the China Valvular Heart Disease study between April and June 2018, were included in this analysis. The primary outcome was all-cause death within 2 years. Of 1825 patients, 165 (9.0%) died during follow-up. Restricted cubic splines revealed that hazard ratio for death increased monotonically with greater modified MELD scores. The MELD-XI and MELD-Albumin scores, as continuous variables or categorized using thresholds determined by maximally selected rank statistics, were independently associated with 2-year mortality (all adjusted P < 0.001). Both scores provided incremental value over prognostic model without hepatorenal indexes {MELD-XI score: net reclassification index [95% confidence interval (95% CI), 0.237 (0.138-0.323)]; MELD-Albumin score: net reclassification index (95% CI), 0.220 (0.122-0.302)}. Results were similar in clinically meaningful subgroups, including but not limited to patients under medical treatment and those with normal left ventricular ejection fraction. Models including modified MELD scores were established for prognostic evaluation of significant TR. CONCLUSION: Both MELD-XI and MELD-Albumin scores provided incremental prognostic information and could play important roles in risk assessment in patients with significant TR.
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Lv et al. (2022) conducted a cohort in significant tricuspid regurgitation (n=1,825). MELD-XI and MELD-Albumin scores vs. Prognostic model without hepatorenal indexes was evaluated on all-cause death within 2 years (NRI 0.237, 95% CI 0.138-0.323, p=< 0.001). MELD-XI and MELD-Albumin scores provided incremental prognostic value for 2-year all-cause mortality over models without hepatorenal indexes (MELD-XI NRI 0.237; 95% CI 0.138-0.323).
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