Implications of Alternative Hepato-Renal Prognostic Scoring Systems in Acute Heart Failure (From DOSE-AHF and ROSE-AHF)

• Published in: The American journal of cardiology Vol. 119; no. 12; pp. 2003 - 2009
• Main Authors: Grodin, Justin L., MD MPH, Gallup, Dianne, MS, Anstrom, Kevin J., PhD, Felker, G. Michael, MD MHS, Chen, Horng H., MD, Tang, W.H.Wilson, MD
• Format: Journal Article
• Language: English
• Published: 29.03.2017
• Subjects: Cardiovascular; cardiorenal; MELD scoring; Acute heart failure
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2017.03.031

Abstract Because hepatic dysfunction is common in patients with heart failure, the Model for End-Stage Liver Disease (MELD) may be attractive for risk-stratification. Although alternative scores such as the MELD-XI or MELD-Na may be more appropriate in heart failure populations, the short-term clinical implications of these in patients with acute heart failure (AHF) are unknown. The MELD-XI and MELD-Na were calculated at baseline in 453 patients with AHF in the DOSE-AHF and ROSE-AHF trials. The correlations and associations for each score with cardiorenal biomarkers, short-term endpoints at 72 hours including worsening renal function and clinical events to 60 days were determined. The median MELD-XI and MELD-Na was 16 and 17, respectively. Both were correlated with baseline cystatin C, NT-proBNP, and plasma renin activity (P<0.003 for all). MELD-XI≤16 and MELD-Na≤17 were associated with a slight increase in cystatin C (P<0.02 for both), higher diuretic efficiency (P<0.001 for both), but not with change in global VAS scores (P>0.05 for both) at 72 hours. Neither score was associated with CRS or worsening heart failure (P>0.05 for all). Similarly, both the MELD-XI and MELD-Na were not associated with 60-day death/any re-hospitalization and 60-day death/heart failure re-hospitalization in adjusted analyses when analyzes as a dichotomous or continuous variable (P>0.05 for all). The alternative MELD scores correlated with baseline cardiorenal biomarkers. In conclusion, lower baseline MELD scoring was associated with higher diuretic efficiency and a slight increase in cystatin C through 72 hours. However, MELD-Na and MELD-XI were not predictive of 60-day clinical events.