title: Liver dysfunction assessed by model for end-stage liver disease excluding INR (MELD-XI) scoring system predicts adverse prognosis in heart failure.
abstract: OBJECTIVE
  Liver dysfunction due to heart failure (HF) is often referred to as cardiac or congestive hepatopathy. The composite Model for End-Stage Liver Disease excluding INR (MELD-XI) is a robust scoring system of liver function, and a high score is associated with poor prognosis in advanced HF patients with a heart transplantation and/or ventricular assist device. However, the impact of MELD-XI on the prognosis of HF patients in general remains unclear.
  
  
  RESULTS
  We retrospectively analyzed 562 patients who were admitted to our hospital for the treatment of decompensated HF. A MELD-XI score was graded, and patients were divided into two groups based on the median value of MELD-XI score: Group L (MELD-XI <10, n = 289) and Group H (MELD-XI ≥10, n = 273). We compared all-cause mortality and echocardiographic findings between the two groups. In the follow-up period (mean 471 days), 104 deaths (62 cardiac deaths and 42 non-cardiac deaths) were observed. The event (cardiac death, non-cardiac death, all-cause death)-free rate was significantly higher in group L than in group H (logrank P<0.05, respectively). In the Cox proportional hazard analysis, a high MELD-XI score was found to be an independent predictor of cardiac deaths and all-cause mortality in HF patients. Regarding echocardiographic parameters, right atrial and ventricular areas, inferior vena cava diameter, and systolic pulmonary artery pressure were higher in group H than in group L (P<0.05, respectively).
  
  
  CONCLUSIONS
  The MELD-XI scoring system, a marker of liver function, can identify high-risk patients with right heart volume overload, higher pulmonary arterial pressure and multiple organ failure associated with HF.
authors: Department of Cardiology and Hematology, Fukushima Medical University, Fukushima, Japan.
authors: Satoshi
authors: S
authors: Abe
authors: Department of Cardiology and Hematology, Fukushima Medical University, Fukushima, Japan; Department of Advanced Cardiac Therapeutics, Fukushima Medical University, Fukushima, Japan.
authors: Akiomi
authors: A
authors: Yoshihisa
authors: Department of Cardiology and Hematology, Fukushima Medical University, Fukushima, Japan.
authors: Mai
authors: M
authors: Takiguchi
authors: Department of Cardiology and Hematology, Fukushima Medical University, Fukushima, Japan.
authors: Takeshi
authors: T
authors: Shimizu
authors: Department of Cardiology and Hematology, Fukushima Medical University, Fukushima, Japan.
authors: Yuichi
authors: Y
authors: Nakamura
authors: Department of Cardiology and Hematology, Fukushima Medical University, Fukushima, Japan.
authors: Hiroyuki
authors: H
authors: Yamauchi
authors: Department of Cardiology and Hematology, Fukushima Medical University, Fukushima, Japan.
authors: Shoji
authors: S
authors: Iwaya
authors: Department of Cardiology and Hematology, Fukushima Medical University, Fukushima, Japan.
authors: Takashi
authors: T
authors: Owada
authors: Department of Cardiology and Hematology, Fukushima Medical University, Fukushima, Japan.
authors: Makiko
authors: M
authors: Miyata
authors: Department of Cardiology and Hematology, Fukushima Medical University, Fukushima, Japan.
authors: Takamasa
authors: T
authors: Sato
authors: Department of Cardiology and Hematology, Fukushima Medical University, Fukushima, Japan; Department of Advanced Cardiac Therapeutics, Fukushima Medical University, Fukushima, Japan.
authors: Satoshi
authors: S
authors: Suzuki
authors: Department of Cardiology and Hematology, Fukushima Medical University, Fukushima, Japan.
authors: Masayoshi
authors: M
authors: Oikawa
authors: Department of Cardiology and Hematology, Fukushima Medical University, Fukushima, Japan.
authors: Atsushi
authors: A
authors: Kobayashi
authors: Department of Cardiology and Hematology, Fukushima Medical University, Fukushima, Japan.
authors: Takayoshi
authors: T
authors: Yamaki
authors: Department of Cardiology and Hematology, Fukushima Medical University, Fukushima, Japan.
authors: Koichi
authors: K
authors: Sugimoto
authors: Department of Cardiology and Hematology, Fukushima Medical University, Fukushima, Japan.
authors: Hiroyuki
authors: H
authors: Kunii
authors: Department of Cardiology and Hematology, Fukushima Medical University, Fukushima, Japan.
authors: Kazuhiko
authors: K
authors: Nakazato
authors: Department of Cardiology and Hematology, Fukushima Medical University, Fukushima, Japan.
authors: Hitoshi
authors: H
authors: Suzuki
authors: Department of Cardiology and Hematology, Fukushima Medical University, Fukushima, Japan.
authors: Shu-ichi
authors: S
authors: Saitoh
authors: Department of Cardiology and Hematology, Fukushima Medical University, Fukushima, Japan; Department of Advanced Cardiac Therapeutics, Fukushima Medical University, Fukushima, Japan.
authors: Yasuchika
authors: Y
authors: Takeishi
mesh_terms: D000368:Aged; D003643:Death; D058625:End Stage Liver Disease / Q000150:complications* / Q000503:physiopathology*; D005260:Female; D006333:Heart Failure / Q000150:complications* / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology*; D006801:Humans; D019934:International Normalized Ratio; D053208:Kaplan-Meier Estimate; D008107:Liver Diseases / Q000150:complications* / Q000503:physiopathology*; D008297:Male; D011379:Prognosis; D016016:Proportional Hazards Models; D014463:Ultrasonography