A high baseline MELD-XI score was associated with an increased risk of sudden death, heart failure death, or cardiac transplantation in Fontan patients (HR 7.76; 95% CI 2.05-29.33; p=0.008).
Cohort (n=96)
No
Does a high MELD-XI score predict risk for cardiac mortality or transplantation in patients with Fontan circulation?
The MELD-XI score is a strong independent predictor of sudden cardiac death, heart failure death, or cardiac transplantation in adult survivors of the Fontan operation.
Hazard Ratio: 7.76 (95% CI 2.05–29.33)
p-value: p=0.008
OBJECTIVE: The Fontan operation is a staged palliation for complex congenital heart disease and single ventricle physiology. Perioperative survivors of the Fontan operation experience long-term cardiac complications, including death. Liver and renal dysfunction are reported in these patients and have a direct effect on morbidity and mortality. This study aims to investigate whether the Model for End-stage Liver Disease eXcluding INR score (function of creatinine and total bilirubin, MELD-XI) predicts risk for cardiac mortality or transplantation in patients with Fontan circulation. DESIGN AND SETTING: Retrospective, single-centre study. Time of first evaluation was the time of the earliest available MELD-XI score measurement, and follow-up was terminated by a cardiac event or by the last clinical evaluation. PATIENTS: Patients surviving after Fontan surgery and evaluated at Boston Children's Hospital between 1993 and 2008. MAIN OUTCOME MEASURE: Composite endpoint of sudden death, death from congestive heart failure or cardiac transplantation. RESULTS: The MELD-XI score was calculated as MELD-XI=11.76(loge creatinine)+5.112(loge total bilirubin)+9.44. Ninety-six patients were included (52 male, median age 26 years). After a mean follow-up period of 5.7 years, 18 patients (19%) experienced the composite end point. Baseline MELD-XI score was independently and directly related to the incidence of the composite endpoint (HR for high MELD-XI score group of 7.76, 95% CI 2.05 to 29.33, p=0.008). CONCLUSIONS: Fontan patients with a higher MELD-XI score have shorter freedom from sudden cardiac death, death from congestive heart failure and cardiac transplantation.
Assenza et al. (2013) conducted a cohort in Fontan circulation (n=96). High MELD-XI score vs. Low MELD-XI score was evaluated on Composite endpoint of sudden death, death from congestive heart failure or cardiac transplantation (HR 7.76, 95% CI 2.05-29.33, p=0.008). A high baseline MELD-XI score was associated with an increased risk of sudden death, heart failure death, or cardiac transplantation in Fontan patients (HR 7.76; 95% CI 2.05-29.33; p=0.008).