title: Preoperative levels of bilirubin or creatinine adjusted by age can predict their reversibility after implantation of left ventricular assist device.
abstract: BACKGROUND
  It is often difficult to predict reversibility of liver or renal function after left ventricular assist device (LVAD) implantation in patients with stage D heart failure.
  
  
  RESULTS
  Data were obtained for 69 patients who had received a LVAD (18 continuous-flow, 51 pulsatile). Persistent hepatic or renal dysfunction was defined as levels of total bilirubin (TB) or creatinine (Cre) >1.5mg/dl at 6 months after LVAD implantation. TB score or Cre score was calculated: 0.15 × age+1.1 × (preoperative TB) or 0.2 × age+3.6 × (preoperative Cre), in which coefficients were determined on the basis of odds ratios for persistent hepatic or renal dysfunction, respectively. Receiver-operating characteristics analyses showed good predictabilities for persistent end-organ dysfunction (area under curve: 0.794 for TB score and 0.839 for Cre score). High-risk strata of TB score (>11.0 points) or Cre score (>14.1 points) were associated with persistently higher levels of TB or Cre (TB, 1.32 ± 0.51; Cre, 1.23 ± 0.41 mg/dl; both P<0.001 vs. low-risk strata).
  
  
  CONCLUSIONS
  Reversibility of end-organ function with LVAD implantation can be well predicted by our new risk scoring system that consists of the preoperative TB or Cre level adjusted by the patient's age. The scoring system would be beneficial, especially in considering the indication of a bridge to candidacy.
authors.affiliation: Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
authors.forename: Teruhiko
authors.initials: T
authors.lastname: Imamura
authors.forename: Koichiro
authors.initials: K
authors.lastname: Kinugawa
authors.forename: Taro
authors.initials: T
authors.lastname: Shiga
authors.forename: Miyoko
authors.initials: M
authors.lastname: Endo
authors.forename: Naoko
authors.initials: N
authors.lastname: Kato
authors.forename: Toshiro
authors.initials: T
authors.lastname: Inaba
authors.forename: Hisataka
authors.initials: H
authors.lastname: Maki
authors.forename: Masaru
authors.initials: M
authors.lastname: Hatano
authors.forename: Atsushi
authors.initials: A
authors.lastname: Yao
authors.forename: Takashi
authors.initials: T
authors.lastname: Nishimura
authors.forename: Yasunobu
authors.initials: Y
authors.lastname: Hirata
authors.forename: Shunei
authors.initials: S
authors.lastname: Kyo
authors.forename: Minoru
authors.initials: M
authors.lastname: Ono
authors.forename: Ryozo
authors.initials: R
authors.lastname: Nagai
mesh_terms: D000328:Adult; D001663:Bilirubin / Q000097:blood*; D003404:Creatinine / Q000097:blood*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood* / Q000150:complications / Q000601:surgery*; D006353:Heart-Assist Devices; D006801:Humans; D007668:Kidney / Q000378:metabolism; D008099:Liver / Q000378:metabolism; D017093:Liver Failure / Q000097:blood* / Q000150:complications / Q000601:surgery; D008297:Male; D008875:Middle Aged; D057234:Preoperative Period; D051437:Renal Insufficiency / Q000097:blood* / Q000150:complications / Q000601:surgery
chemical_list: D003404:Creatinine; D001663:Bilirubin