Backgrounds: Hospitalization for acute decompensated heart failure (ADHF) is associated with high mortality after discharge. Liver dysfunction has a prognostic impact on the outcome of patients with advanced heart failure. A model of end-stage liver disease excluding INR (MELD-XI), a robust scoring system of liver dysfunction, has been shown to provide prognostic information in heart failure patients. Acute kidney injury (AKI) during heart failure treatment is associated with poor outcome in patients admitted for ADHF. However, there is no information available on the long-term prognostic significance of MELD-XI score in patients admitted for ADHF, relating to AKI.
Methods and Results: We studied 303 consecutive ADHF patients discharged with survival. MELD-XI score was calculated by the following formula: 5.11 ln(bilirubin)+11.79 ln(creatinine)+9.44. AKI during ADHF treatment was defined according to AKI Network criteria (stage 1: ≥0.3mg/dl absolute or 1.5- to 2.0-fold relative increase in Cr, stage 2: >2- to 3-fold increase in Cr, stage 3: >3-fold increase in Cr or Cr≥4.0mg/dl with an acute rise of ≥0.5mg/dl). During a follow-up period of 4.1±3.2 yrs, 81 patients had cardiovascular-renal poor outcome, defined as cardiovascular death and the development of end-stage renal disease requiring renal replacement therapy. At multivariate Cox analysis, MELD-XI score (p<0.0001) and AKI (p=0.0058) were significantly independently associated with cardiovascular-renal poor outcome, independently of systolic blood pressure, serum sodium level and prior heart failure hospitalization. In each AKI stage, MELD-XI score was a significant predictor of cardiovascular-renal poor outcome (c-index: 0.682[0.530-0.832], 0.740[0.642-0.838] and 0.648[0.542-0.754] in AKI stage 2/3, stage 1 and no AKI, respectively).
Conclusion: A MELD-XI scoring system could provide the additional long-term prognostic information to AKI in ADHF patients.