title: Impaired hepato-renal function defined by the MELD XI score as prognosticator in acute heart failure.
abstract: Multi-organ dysfunction often complicates the natural course of acute heart failure (AHF) and identifies patients with poor prognosis. The MELD score (Model of End-Stage Liver Dysfunction) combines data reflecting liver and kidney function, which makes it a potentially useful tool for the assessment of patients with AHF. The aim of this study was to assess the prognostic utility of the MELD score in patients with AHF.
  
  
  
  The MELD score was calculated on admission and during hospital stay (days 2-3) using a formula that does not take into account the international normalized ratio (MELD XI). The study population consisted of 203 AHF patients (mean age 65 ± 12 years, 76% male). The mean MELD XI score was -14.8 ± 4.5 points on admission and 13.9 ± 4.3 points during hospitalization. Contributors of elevated MELD XI score at baseline and during hospital stay were isolated increase in creatinine in 22-25%, isolated increase in bilirubin in 17-19%, and abnormal values of both in 40-46% of patients. During 1-year follow-up, 67 (33%) patients died. After adjustment for well-established prognosticators, MELD XI score at baseline and during hospital stay were significant predictors of poor outcome [hazard ratio (95% confidence interval): 1.11 (1.05-1.2) and 1.14 (1.09-1.2), respectively, P < 0.001]. An increase in the MELD XI score during hospital stay occurred in 31% of patients and was related to increased risk of death at 1 year [1.97 (1.2-3.2), P < 0.005].
  
  
  
  Impairment of hepato-renal function defined by the MELD XI score is common and carries unfavourable prognosis in AHF patients.
authors.affiliation: Centre for Heart Diseases, Military Hospital, Wroclaw, Poland.|Department of Heart Diseases, Medical University, Wroclaw, Poland.
authors.forename: Jan
authors.initials: J
authors.lastname: Biegus
authors.affiliation: Centre for Heart Diseases, Military Hospital, Wroclaw, Poland.
authors.forename: Robert
authors.initials: R
authors.lastname: Zymliński
authors.affiliation: Centre for Heart Diseases, Military Hospital, Wroclaw, Poland.|Department of Heart Diseases, Medical University, Wroclaw, Poland.
authors.forename: Mateusz
authors.initials: M
authors.lastname: Sokolski
authors.affiliation: Centre for Heart Diseases, Military Hospital, Wroclaw, Poland.
authors.forename: Paweł
authors.initials: P
authors.lastname: Siwołowski
authors.affiliation: Centre for Heart Diseases, Military Hospital, Wroclaw, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Gajewski
authors.affiliation: Centre for Heart Diseases, Military Hospital, Wroclaw, Poland.
authors.forename: Sylwia
authors.initials: S
authors.lastname: Nawrocka-Millward
authors.affiliation: Gastroenterology and Hepatology Department, Wroclaw Medical University, Poland.
authors.forename: Elżbieta
authors.initials: E
authors.lastname: Poniewierka
authors.affiliation: Centre for Heart Diseases, Military Hospital, Wroclaw, Poland.|Department of Heart Diseases, Medical University, Wroclaw, Poland.
authors.forename: Ewa A
authors.initials: EA
authors.lastname: Jankowska
authors.affiliation: Centre for Heart Diseases, Military Hospital, Wroclaw, Poland.
authors.forename: Waldemar
authors.initials: W
authors.lastname: Banasiak
authors.affiliation: Centre for Heart Diseases, Military Hospital, Wroclaw, Poland.|Department of Heart Diseases, Medical University, Wroclaw, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Ponikowski
mesh_terms: D000208:Acute Disease; D000368:Aged; D001663:Bilirubin / Q000378:metabolism*; D003404:Creatinine / Q000378:metabolism*; D058625:End Stage Liver Disease; D005260:Female; D006333:Heart Failure / Q000378:metabolism* / Q000503:physiopathology; D006760:Hospitalization; D006801:Humans; D053208:Kaplan-Meier Estimate; D007677:Kidney Function Tests; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D009026:Mortality; D015999:Multivariate Analysis; D020097:Natriuretic Peptide, Brain / Q000378:metabolism; D010446:Peptide Fragments / Q000378:metabolism; D011379:Prognosis; D016016:Proportional Hazards Models; D012720:Severity of Illness Index; D013318:Stroke Volume; D015996:Survival Rate
chemical_list: D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D003404:Creatinine; D001663:Bilirubin
keywords: Acute heart failure; Kidney function; Liver function; MELD XI; Prognosis