title: Liver dysfunction as predictor of prognosis in patients with amyloidosis: utility of the Model for End-stage Liver disease (MELD) scoring system.
abstract: Amyloidosis prognosis is often related to the onset of heart failure and a worsening that is concomitant with kidney-liver dysfunction; thus the Model for End-stage Liver disease (MELD) may be an ideal instrument to summarize renal-liver function. Our aim has been to test the MELD score as a prognostic tool in amyloidosis. We evaluated 128 patients, 46 with TTR-related amyloidosis and 82 with AL amyloidosis. All patients had a complete clinical and echocardiography evaluation; overall biohumoral assessment included troponin I, NT-proBNP, creatinine, total bilirubin and INR ratio. The study population was dichotomized at the 12 cut-off level of MELD scores; those with MELD score >12 had a lower survival compared to controls in the study cohort (40.7 vs 66.3 %; p = 0.006). Either as a continuous and dichotomized variable, MELD shows its independent prognostic value at multivariable analysis (HR = 1.199, 95 % CI 1.082-1.329; HR = 2.707, 95 % CI 1.075-6.817, respectively). MELD shows a lower prognostic sensitivity/specificity ratio than troponin I and NT-proBNP in the whole study population and AL subgroup, while in TTR patients MELD has a higher sensitivity/specificity ratio compared to troponin and NT-proBNP (ROC analysis-AUC: 0.853 vs 0.726 vs 0.659). MELD is able to predict prognosis in amyloidosis. A MELD score >12 selects a subgroup of patients with a higher risk of death. The predictive accuracy seems to be more evident in TTR patients in whom currently no effective scoring systems have been validated.
authors.affiliation: Intensive Cardiac Unit, Department of Heart and Vessels, University of Florence and Azienda Ospedaliero-Universitaria Careggi [AOUC], Largo Brambilla 3, 50134, Florence, Italy. cappellifrancesco@inwind.it.|Regional Amyloid Centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy. cappellifrancesco@inwind.it.
authors.forename: Francesco
authors.initials: F
authors.lastname: Cappelli
authors.affiliation: Intensive Cardiac Unit, Department of Heart and Vessels, University of Florence and Azienda Ospedaliero-Universitaria Careggi [AOUC], Largo Brambilla 3, 50134, Florence, Italy.|Research Unit of Medicine of Aging, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
authors.forename: Samuele
authors.initials: S
authors.lastname: Baldasseroni
authors.affiliation: Regional Amyloid Centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Bergesio
authors.affiliation: Intensive Cardiac Unit, Department of Heart and Vessels, University of Florence and Azienda Ospedaliero-Universitaria Careggi [AOUC], Largo Brambilla 3, 50134, Florence, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Spini
authors.affiliation: Department of Heart and Vessels, University of Florence, Florence, Italy.
authors.forename: Alessia
authors.initials: A
authors.lastname: Fabbri
authors.affiliation: Department of Heart and Vessels, University of Florence, Florence, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Angelotti
authors.affiliation: Department of Internal Medicine, University of Florence, Florence, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Grifoni
authors.affiliation: Department of Internal Medicine, University of Florence, Florence, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Attanà
authors.affiliation: Research Unit of Medicine of Aging, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Tarantini
authors.affiliation: Research Unit of Medicine of Aging, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
authors.forename: Niccolò
authors.initials: N
authors.lastname: Marchionni
authors.affiliation: Department of Internal Medicine, University of Florence, Florence, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Moggi Pignone
authors.affiliation: Regional Amyloid Centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.|Department of Internal Medicine, University of Florence, Florence, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Perfetto
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000686:Amyloidosis / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D003661:Decision Support Techniques; D058625:End Stage Liver Disease / Q000145:classification* / Q000453:epidemiology; D005260:Female; D006801:Humans; D007558:Italy; D008107:Liver Diseases / Q000150:complications* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012372:ROC Curve; D018570:Risk Assessment / Q000379:methods* / Q000592:standards
keywords: Amyloid; Liver dysfunction; MELD; Prognosis