title: Predictive Value of the Model for End-Stage Liver Disease Score Excluding International Normalized Ratio One Year After Orthotopic Heart Transplantation.
abstract: BACKGROUND
  The Model for End-Stage Liver Disease (MELD) scoring system incorporating a combination of hepatic and renal laboratory parameters does not adequately reflect the degree of multi-organ dysfunction in patients with heart failure, who need oral anticoagulation. In order to exclude the impact of oral anticoagulation on the international normalized ratio (INR), we used the MELD excluding INR (MELD-XI) score. The aims of the study were to calculate the individual preoperative MELD-XI score and its ability to predict 1-year mortality after heart transplantation and to identify other preoperative laboratory prognostic parameters.
  
  
  METHODS
  We retrospectively analysed data of 87 consecutive adults undergoing heart transplantation between 2011 and 2014. Clinical data and laboratory parameters for the calculation of the MELD-XI score were obtained at the time of admission for the heart transplantation.
  
  
  RESULTS
  The average age of the patients was 48.8 ± 13.3 years and 68.9% of them were male. During the observation period, the mortality rate was 18.4%. Multivariate analysis of Cox proportional hazard confirmed that the pretransplantation MELD-XI score (hazard ratio [HR] = 1.625 [1.286-2.053]; P < .001), sodium serum concentration (HR = 0.824 [0.677-1.001]; P < .05) and highly sensitive C-reactive protein (hs-CRP) serum concentration (HR = 1.045 [1.008-1.083]; P < .02) were independent predictors of death during the first year after heart transplantation. Area under the receiver operating characteristic (ROC) curve (AUC) indicated a good discriminatory power of MELD-XI (AUC 0.997; P < .04) and plasma sodium concentration (AUC 0.901; P < .01) in death prediction.
  
  
  CONCLUSIONS
  Our study confirms that the pretransplantation MELD-XI score, as well as serum sodium and hsCRP concentrations, may be used to estimate postoperative risk in heart transplant recipients during a 1-year follow-up.
authors: 3(rd) Department of Cardiology, SMDZ in Zabrze, Medical University of Silesia, Silesian Center for Heart Diseases, Katowice, Poland. Electronic address: centrala4@wp.pl.
authors: B
authors: B
authors: Szyguła-Jurkiewicz
authors: Department of Cardiosurgery, Transplantation and Cardiovascular Surgery, SMDZ in Zabrze, Medical University of Silesia, Katowice, Poland.
authors: M
authors: M
authors: Zakliczyński
authors: Silesian Center for Heart Diseases, Katowice, Poland.
authors: W
authors: W
authors: Szczurek
authors: Clinical Department of Cardiac Anaesthesia and Intensive Care, SMDZ in Zabrze, Medical University of Silesia, Katowice, Poland.
authors: P
authors: P
authors: Nadziakiewicz
authors: 3(rd) Department of Cardiology, SMDZ in Zabrze, Medical University of Silesia, Silesian Center for Heart Diseases, Katowice, Poland.
authors: M
authors: M
authors: Gąsior
authors: Department of Cardiosurgery, Transplantation and Cardiovascular Surgery, SMDZ in Zabrze, Medical University of Silesia, Katowice, Poland.
authors: M
authors: M
authors: Zembala
mesh_terms: D000328:Adult; D000368:Aged; D002097:C-Reactive Protein / Q000032:analysis; D005260:Female; D006333:Heart Failure / Q000401:mortality; D016027:Heart Transplantation / Q000401:mortality*; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012372:ROC Curve; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012964:Sodium / Q000097:blood; D055815:Young Adult
chemical_list: D002097:C-Reactive Protein; D012964:Sodium