Prognostic value of model for end-stage liver disease excluding international normalized ratio score combined with late gadolinium enhancement in heart failure with reduced ejection fraction

Q: What are the key findings of this study?

MELD-XI score (HR 1.60 per SD) and LGE (HR 1.52 per SD) independently predicted HF rehospitalization or death in HFrEF, with combined high levels conferring an HR of 11.41.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Heart failure with reduced ejection fraction (HFrEF) (n=246). Intervention: Model for end-stage liver disease excluding international normalized ratio (MELD-XI) score (per 1-SD increase) vs. Lower MELD-XI score / Late gadolinium enhancement (LGE). Primary outcome: Composite of rehospitalization for heart failure and all-cause mortality (HR 1.60, 95% CI 1.31-1.94, p=<0.001).

Q: What does this research mean for the field?

Both CMR-assessed late gadolinium enhancement and MELD-XI score independently predict heart failure rehospitalization or all-cause mortality in patients with HFrEF, and combining them provides incremental prognostic value. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To evaluate the individual and combined prognostic performance of late gadolinium enhancement on cardiac magnetic resonance and the MELD-XI score in patients with heart failure with reduced ejection fraction.

Linsong Leng; Shuai Zhang; Tianhao Wei; Dachuan Guo; Qian Wang; Yu Bai; Sha Chen; Chenxi Zhao; Huixia Lu; Cheng Zhang; Jianmin Yang

doi:10.3389/fcvm.2026.1891852

November 4, 2026Frontiers in Cardiovascular MedicineOpen Access

Prognostic value of model for end-stage liver disease excluding international normalized ratio score combined with late gadolinium enhancement in heart failure with reduced ejection fraction

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Key result

Higher MELD-XI score is linked to ~60% higher risk of death or HF rehospitalization per SD.

HR 1.60
95% CI 1.31-1.94
P<0.001
n=246

Why the study?

The MELD-XI score and CMR-assessed LGE each independently predict adverse prognosis in heart failure, prompting evaluation of the incremental prognostic value of combining them in patients with HFrEF.

Does combining the MELD-XI score with CMR-assessed late gadolinium enhancement (LGE) improve prognostic prediction for the composite of heart failure rehospitalization and all-cause mortality in adult patients with HFrEF?

Key Points

To evaluate the individual and combined prognostic performance of late gadolinium enhancement on cardiac magnetic resonance and the MELD-XI score in patients with heart failure with reduced ejection fraction.
Retrospective single-center study evaluating adult patients with heart failure with reduced ejection fraction admitted to Qilu Hospital of Shandong University between September 2018 and January 2023 (N=246).
Late gadolinium enhancement percentage was quantified via cardiac magnetic resonance, and MELD-XI scores were calculated from admission total bilirubin and serum creatinine levels.
The primary endpoint was a composite of heart failure rehospitalization and all-cause mortality, evaluated using multivariate Cox regression.
Over follow-up, 55 patients reached the composite primary endpoint of heart failure rehospitalization or all-cause mortality.
In the adjusted Cox regression model, each standard deviation increase in late gadolinium enhancement was associated with an HR of 1.52 (95% CI: 1.23–1.88), and each standard deviation increase in MELD-XI score had an HR of 1.60 (95% CI: 1.31–1.94).
Adding the MELD-XI score yielded significant incremental prognostic improvement (Δ C-statistic: 0.052, 95% CI: 0.001–0.092, p = 0.039; continuous NRI: 0.399, 95% CI: 0.077–0.532, p = 0.027; IDI: 0.094, 95% CI: 0.018–0.174, p = 0.010).

Study Design

Type

Cohort (n=246)

Blinding

Single-blind

Multicenter

No

Structured PICO

Does combining the MELD-XI score with CMR-assessed late gadolinium enhancement (LGE) improve prognostic prediction for the composite of heart failure rehospitalization and all-cause mortality in adult patients with HFrEF?

P

Population

246 hospitalized adults with HFrEF (mean age 45.5 years, 24.4% female) undergoing CMR, free of primary hepatic/renal disease or severe surgical valvular disease, followed for a median of 22 months.

E

Exposure

Prognostic risk assessment combining model for end-stage liver disease excluding international normalized ratio (MELD-XI) score calculated at admission with late gadolinium enhancement (LGE) percentage assessed by cardiac magnetic resonance (CMR) using intravenous gadopentetate dimeglumine (0.2 mmol/kg).

O

Outcome

Composite of first rehospitalization for heart failure (defined by symptoms/signs such as dyspnea, rales, and ankle edema requiring in-hospital treatment with diuretics, positive inotropic drugs, or mechanical circulatory assistance devices) and all-cause mortality at a median follow-up of 22 months (IQR 12–34 months), ascertained via medical records or telephone follow-up.composite

Main Result

Hazard Ratio: 1.6 (95% CI 1.31–1.94)

p-value: p=<0.001

Combining the hepatorenal MELD-XI score with CMR-derived late gadolinium enhancement provides significant incremental prognostic value for predicting heart failure rehospitalization and all-cause mortality in patients with HFrEF.

Limitations

Single-center retrospective design with potential referral and selection bias due to CMR eligibility requirements
Lack of post-discharge laboratory data prevented analysis of dynamic changes in MELD-XI score
Uncertainty remains in NRI and IDI estimates despite accounting for censoring
Low number of deaths limited statistical power for the secondary endpoint of all-cause mortality
Limited sample size resulted in non-significant RERI and AP in interaction analyses
Lack of external validation restricts generalizability to other populations

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Implication

May support combined MELD-XI and LGE risk stratification in HFrEF; hypothesis-generating and requires prospective validation before adoption.

Abstract

Introduction Heart failure with reduced ejection fraction (HFrEF) is one of the main subtypes of heart failure (HF). Model for end-stage liver disease excluding international normalized ratio (MELD-XI) score and late gadolinium enhancement (LGE) assessed by cardiac magnetic resonance (CMR) each independently predict adverse prognosis in HF patients. Methods This retrospective study enrolled adult HFrEF patients admitted to Qilu Hospital of Shandong University between September 2018 and January 2023. The primary endpoint was defined as a composite endpoint of rehospitalization for HF and all-cause mortality. Multivariate Cox regression model was established to evaluate the effects of LGE and MELD-XI score on the primary endpoint. We also evaluate the incremental prognostic value of adding the MELD-XI score to the model. Results A total of 246 HFrEF patients were included and 55 patients reached the primary endpoint during follow-up. In the adjusted Cox regression model, for each standard deviation increase in LGE and MELD-XI score, the hazard ratios (HRs) for primary endpoint were 1.52 (95% CI: 1.23–1.88) and 1.60 (95% CI: 1.31–1.94), respectively. Adding MELD-XI score into model improved its incremental prognostic performance [ Δ C-Statistic: 0.052 (95% CI: 0.001–0.092), p = 0.039; Continuous NRI: 0.399 (95% CI: 0.077–0.532), p = 0.027; IDI: 0.094 (95% CI: 0.018–0.174), p = 0.010]. Conclusions Both CMR-assessed LGE and MELD-XI score were associated with adverse outcomes in patients with HFrEF. Combining these two indicators provided complementary prognostic information for HFrEF patients.

Discussion

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Cite This Study

Leng et al. (2026) conducted a cohort in Heart failure with reduced ejection fraction (HFrEF) (n=246). Model for end-stage liver disease excluding international normalized ratio (MELD-XI) score (per 1-SD increase) vs. Lower MELD-XI score / Late gadolinium enhancement (LGE) was evaluated on Composite of rehospitalization for heart failure and all-cause mortality (HR 1.60, 95% CI 1.31-1.94, p=<0.001). MELD-XI score (HR 1.60 per SD) and LGE (HR 1.52 per SD) independently predicted HF rehospitalization or death in HFrEF, with combined high levels conferring an HR of 11.41.

synapsesocial.com/papers/6aed6e093dd5ffb8e184c526 https://doi.org/10.3389/fcvm.2026.1891852

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Prognostic value of model for end-stage liver disease excluding international normalized ratio score combined with late gadolinium enhancement in heart failure with reduced ejection fraction

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Prognostic value of model for end-stage liver disease excluding international normalized ratio score combined with late gadolinium enhancement in heart failure with reduced ejection fraction

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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