title: Model for end-stage liver disease score predicts adverse events related to ventricular assist device therapy.
abstract: BACKGROUND
  The Model for End-stage Liver Disease (MELD) score is a marker of multisystem organ dysfunction. It has been used to predict outcomes in patients undergoing hepatic and nonhepatic interventions. End-stage heart disease exhibits a varying degree of multiorgan dysfunction, which impacts the adverse events related to ventricular assist device (VAD) therapy. Our aim for the present study was to investigate the value of MELD score in predicting adverse events related with VAD therapy.
  
  
  METHODS
  Data were collected on demographics, clinical characteristics, MELD score; Interagency Registry for Mechanically Assisted Circulatory Support-defined VAD adverse events within the first 6 months, and survival from VAD recipients (n=286; from 1996 to 2009). Univariable, multivariable, and Cox regression analyses were performed using SAS software (SAS Institute, Cary, NC).
  
  
  RESULTS
  The mean MELD score was 14.4±5.9. Actuarial incidence of infections, bleeding events, and cardiovascular dysfunction at 6 months was 65.4%, 52.1%, and 45.6%, respectively. Multivariable Cox proportional hazards model (controlling for gender, type of device, diagnosis, intention to treat, urgency, and inotropic use) confirmed that MELD score predicted mortality, respiratory, and renal dysfunction at 6 months (p<0.01).
  
  
  CONCLUSIONS
  Preoperative MELD score is predictive of mortality, respiratory, and renal dysfunction at 6 months after controlling for gender, type of device, diagnosis, intention to treat, urgency, and inotropic use. The MELD score may be used as a quantitative tool to assess the adverse events associated with VAD therapy.
authors.affiliation: Section of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA.
authors.forename: Pramod
authors.initials: P
authors.lastname: Bonde
authors.forename: Natalie C
authors.initials: NC
authors.lastname: Ku
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Genovese
authors.forename: Christian A
authors.initials: CA
authors.lastname: Bermudez
authors.forename: Jay K
authors.initials: JK
authors.lastname: Bhama
authors.forename: Maria M
authors.initials: MM
authors.lastname: Ciarleglio
authors.forename: Xiangyu
authors.initials: X
authors.lastname: Cong
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Teuteberg
authors.forename: Robert L
authors.initials: RL
authors.lastname: Kormos
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D002423:Cause of Death; D015331:Cohort Studies; D058625:End Stage Liver Disease / Q000145:classification* / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D006352:Heart Ventricles / Q000601:surgery; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008955:Models, Cardiovascular; D015233:Models, Statistical; D009102:Multiple Organ Failure / Q000401:mortality* / Q000503:physiopathology; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012372:ROC Curve; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D016896:Treatment Outcome