title: Predictive Value of Hepatic and Renal Dysfunction Based on the Models for End-Stage Liver Disease in Patients With Heart Failure Evaluated for Heart Transplant.
abstract: BACKGROUND
  The evaluation of prognosis and determination of a long-term treatment strategy is an important element of management in patients with heart failure (HF).
  
  
  METHODS
  The aim of the study was to determine the prognostic value of the Model for End-Stage Liver Disease (MELD) and its modifications, MELD and serum sodium (MELD-Na) and MELD excluding the international normalized ratio (MELD-XI), as well as other independent risk factors for death during a 4-year follow-up. We analyzed retrospectively 143 patients with advanced HF, evaluated for heart transplant between 2009 and 2011. Patients using warfarin were excluded from the study. The long-term follow-up data were obtained during follow-up visits and/or phone contact with the patients or their families.
  
  
  RESULTS
  The age of the patients was 54 (48-59) years and 88.1% of patients were male. Mortality rate during the follow-up period was 49%. The MELD scores (hazard ratio [HR], 1.12; P < .001), as well as serum high-sensitivity C-reactive protein (hs-CRP; HR, 1.01; P < .01) and N-terminal pro-brain natriuretic peptide (NT-proBNP; HR, 1.01; P < .05) levels, were independent risk factors for death. Receiver operator characteristic analysis indicated that a MELD cutoff of 10 (area under the curve [AUC], 0.756; P < .0001], MELD-XI cutoff of 13.0 (AUC, 0.720; P < .0001), MELD-Na cutoff of 13.0 (AUC, 0.813; P < .0001), hs-CRP cutoff of 4.02 (AUC, 0.686; P < .001), and NT-proBNP cutoff of 1055 (AUC, 0.722; P < .001) were the best predictive values as predictors of death.
  
  
  CONCLUSIONS
  MELD, MELD-Na, and MELD-XI scores are prognostic factors for death during a 4-year follow-up. A high MELD score is an independent prognostic factor for death. NT-proBNP and hs-CRP serum concentrations are other independent factors influencing death.
authors: 3rd Department of Cardiology, SMDZ in Zabrze, Medical University of Silesia, Katowice, Poland. Electronic address: centrala4@wp.pl.
authors: B
authors: B
authors: Szyguła-Jurkiewicz
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: Department of Cardiosurgery, Transplantation and Cardiovascular Surgery, SMDZ in Zabrze, Medical University of Silesia, Katowice, Poland.
authors: M
authors: M
authors: Zakliczynski
authors: Silesian Center for Heart Diseases, Zabrze, Poland.
authors: W
authors: W
authors: Szczurek
authors: Institute of Materials Science, Silesian University of Technology, Katowice, Poland.
authors: J
authors: J
authors: Chraponski
authors: Department of Cardiosurgery, Transplantation and Cardiovascular Surgery, SMDZ in Zabrze, Medical University of Silesia, Katowice, Poland.
authors: M
authors: M
authors: Zembala
authors: 3rd Department of Cardiology, SMDZ in Zabrze, Medical University of Silesia, Katowice, Poland.
authors: M
authors: M
authors: Gasior
mesh_terms: D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D058625:End Stage Liver Disease / Q000150:complications / Q000401:mortality*; D004812:Epidemiologic Methods; D005260:Female; D006333:Heart Failure / Q000401:mortality / Q000601:surgery*; D016027:Heart Transplantation / Q000401:mortality*; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000378:metabolism; D010446:Peptide Fragments / Q000378:metabolism; D011379:Prognosis; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000401:mortality*
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D002097:C-Reactive Protein