title: Hepatic dysfunction in ambulatory patients with heart failure: application of the MELD scoring system for outcome prediction.
abstract: OBJECTIVE
  This study evaluated the Model for End-Stage Liver Disease (MELD) score and its modified versions, which are established measures of liver dysfunction, as a tool to assess heart transplantation (HTx) urgency in ambulatory patients with heart failure.
  
  
  BACKGROUND
  Liver abnormalities have a prognostic impact on the outcome of patients with advanced heart failure.
  
  
  METHODS
  We retrospectively evaluated 343 patients undergoing HTx evaluation between 2005 and 2009. The prognostic effectiveness of MELD and 2 modifications (MELDNa [includes serum sodium levels] and MELD-XI [does not include international normalized ratio]) for endpoint events, defined as death/HTx/ventricular assist device requirement, was evaluated in our cohort and in subgroups of patients on and off oral anticoagulation.
  
  
  RESULTS
  The MELD and MELDNa scores were excellent predictors for 1-year endpoint events (areas under the curve: 0.71 and 0.73, respectively). High scores (>12) were strongly associated with poor survival at 1 year (MELD 69.3% vs. 90.4% [p < 0.0001]; MELDNa 70.4% vs. 96.9% [p < 0.0001]). Increased scores were associated with increased risk for HTx (hazard ratio: 1.10 [95% confidence interval: 1.06 to 1.14]; p < 0.0001 for both scores), which was independent of other known risk factors (MELD p = 0.0055; MELDNa p = 0.0083). Anticoagulant use was associated with poor survival at 1 year (73.7% vs. 86.4%; p = 0.0118), and the statistical significance of MELD/MELDNa was higher in patients not receiving oral anticoagulation therapy. MELD-XI was a fair but limited predictor of the endpoint events in patients receiving oral anticoagulation therapy.
  
  
  CONCLUSIONS
  Assessment of liver dysfunction according to the MELD scoring system provides additional risk information in ambulatory patients with heart failure.
authors.affiliation: Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, New York.
authors.forename: Margaret S
authors.initials: MS
authors.lastname: Kim
authors.affiliation: Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, New York.
authors.forename: Tomoko S
authors.initials: TS
authors.lastname: Kato
authors.affiliation: Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, New York.
authors.forename: Maryjane
authors.initials: M
authors.lastname: Farr
authors.affiliation: Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, New York.
authors.forename: Christina
authors.initials: C
authors.lastname: Wu
authors.affiliation: Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, New York.
authors.forename: Raymond C
authors.initials: RC
authors.lastname: Givens
authors.affiliation: Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, New York.
authors.forename: Ellias
authors.initials: E
authors.lastname: Collado
authors.affiliation: Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, New York.
authors.forename: Donna M
authors.initials: DM
authors.lastname: Mancini
authors.affiliation: Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, New York.
authors.forename: P Christian
authors.initials: PC
authors.lastname: Schulze
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use; D001663:Bilirubin / Q000097:blood; D001806:Blood Urea Nitrogen; D015992:Body Mass Index; D003404:Creatinine / Q000097:blood; D058625:End Stage Liver Disease / Q000097:blood / Q000150:complications* / Q000401:mortality; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000150:complications* / Q000401:mortality; D016027:Heart Transplantation; D006801:Humans; D019934:International Normalized Ratio; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010101:Oxygen Consumption; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012964:Sodium / Q000097:blood
chemical_list: D000925:Anticoagulants; D020097:Natriuretic Peptide, Brain; D012964:Sodium; D003404:Creatinine; D001663:Bilirubin
references.citation: Circulation. 1997 Jun 17;95(12):2660-7
references.pmid: 9193435
references.citation: Hepatology. 2001 Feb;33(2):464-70
references.pmid: 11172350
references.citation: J Card Fail. 2010 Jan;16(1):84-90
references.pmid: 20123323
references.citation: Am J Cardiol. 2005 Mar 15;95(6):734-41
references.pmid: 15757599
references.citation: Gastroenterology. 2007 Apr;132(4):1261-9
references.pmid: 17408652
references.citation: Cleve Clin J Med. 2006 Jun;73 Suppl 2:S2-7; discussion S30-3
references.pmid: 16786906
references.citation: Circulation. 1991 Mar;83(3):778-86
references.pmid: 1999029
references.citation: Clin Gastroenterol Hepatol. 2004 Aug;2(8):719-23
references.pmid: 15290666
references.citation: Congest Heart Fail. 2011 Jul-Aug;17(4):169-74
references.pmid: 21790966
references.citation: N Engl J Med. 2012 May 17;366(20):1859-69
references.pmid: 22551105
references.citation: J Heart Lung Transplant. 2012 Jun;31(6):591-600
references.pmid: 22458996
references.citation: Eur J Heart Fail. 2009 Feb;11(2):170-7
references.pmid: 19168515
references.citation: Am Heart J. 2004 Jul;148(1):157-64
references.pmid: 15215806
references.citation: Int J Nephrol. 2011;2011:732746
references.pmid: 21603106
references.citation: Circulation. 2010 Jan 19;121(2):214-20
references.pmid: 20048215
references.citation: Eur J Clin Invest. 2012 Feb;42(2):153-63
references.pmid: 21806605
references.citation: J Heart Lung Transplant. 2011 Nov;30(11):1236-43
references.pmid: 21764604
references.citation: Circulation. 2005 May 17;111(19):2454-60
references.pmid: 15867182
references.citation: Hepatology. 2000 Apr;31(4):864-71
references.pmid: 10733541
references.citation: Circulation. 2006 Mar 21;113(11):1424-33
references.pmid: 16534009
references.citation: Liver Transpl. 2007 Jan;13(1):30-7
references.pmid: 17154400
references.citation: Biometrics. 1988 Sep;44(3):837-45
references.pmid: 3203132
references.citation: Arch Intern Med. 2007 Oct 8;167(18):1998-2005
references.pmid: 17923601
references.citation: Circulation. 1986 Feb;73(2):257-67
references.pmid: 3002660
references.citation: N Engl J Med. 2008 Sep 4;359(10):1018-26
references.pmid: 18768945
references.citation: Circ J. 2008 Mar;72(3):364-9
references.pmid: 18296830