Prognostic value of liver dysfunction assessed by MELD-XI scoring system in patients undergoing transcatheter aortic valve implantation

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• 作者：Takahide Arai<sup>asup><sup> ; sup><sup>tarai@a3.keio.jpsup> ; Fumiaki Yashima<sup>asup> ; Ryo Yanagisawa<sup>asup> ; Makoto Tanaka<sup>asup> ; Hideyuki Shimizu<sup>bsup> ; Keiichi Fukuda<sup>asup> ; Yusuke Watanabe<sup>csup> ; Toru Naganuma<sup>dsup> ; Motoharu Araki<sup>esup> ; Norio Tada<sup>fsup> ; Futoshi Yamanaka<sup>gsup> ; Shinichi Shirai<sup>hsup> ; Masanori Yamamoto<sup>isup> ; Kentaro Hayashida<sup>asup> ; OCEAN-TAVI investigators
• 关键词：Severe symptomatic aortic stenosis ; Transcatheter aortic valve implantation ; Liver dysfunction ; MELD-XI score
• 刊名：International Journal of Cardiology
• 出版年：2017
• 出版时间：1 February 2017
• 年：2017
• 卷：228
• 期：Complete
• 页码：648-653
• 全文大小：363 K
• 卷排序：228

文摘

There are limited data regarding the influence of liver dysfunction on outcomes of transcatheter aortic valve implantation (TAVI). Model for End-stage Liver Disease eXcluding International normalized ratio (MELD-XI) score, which was originally developed for patients with cirrhosis awaiting liver transplantation, has been reported as a predictor of heart disease. The aim of this study was to investigate the prognostic value of MELD-XI score for patients undergoing TAVI.MethodsData from the prospectively maintained Optimized transCathEter vAlvular iNtervention (OCEAN-TAVI) multicenter registry were collected in 749 patients who underwent TAVI between October 2013 and August 2015. MELD-XI score was calculated as follows: 11.76 × Ln (creatinine) + 5.11 × Ln (total bilirubin) + 9.44. Patients were categorized based on MELD-XI score > 10 or ≤ 10, and compared with regard to clinical characteristics and outcomes of TAVI.ResultsHigher MELD-XI score was associated with lower 30-day survival (95.6% vs 98.5%, P = 0.03). Kaplan–Meier analysis revealed that higher MELD-XI score also was associated with lower 6-month survival (P < 0.01). Multivariate Cox regression analysis showed that MELD-XI score was an independent predictor of 6-month cumulative mortality. Receiver operating characteristic analysis revealed that MELD-XI score showed better accuracy in predicting 6-month mortality compared with Logistic European System for Cardiac Operative Risk Evaluation, European System for Cardiac Operative Risk Evaluation II, and Society of Thoracic Surgeons scores (area under the curve = 0.67, 0.58, 0.57, and 0.60, respectively).ConclusionEvaluation of liver dysfunction according to MELD-XI score provides additional risk information for patients undergoing TAVI.