The Prognostic Value of Platelet-Albumin-Bilirubin Score in Patients Undergoing Transcatheter Aortic Valve Replacement

IF 2.3 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS
Farman Ullah Khan, Muhammad Ammar ul hassan khan, Muhammad Aamir khan, Shad Khan, Muhammad Ismail
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引用次数: 0

Abstract

We read with great interest the article “The Prognostic Value of Platelet-Albumin-Bilirubin Score in Patients Undergoing Transcatheter Aortic Valve Replacement.” by Duan et al. [1]. Reading such a well-written and complete piece is satisfying and the author's efforts on this important subject must be acknowledged. This study comprehensively evaluates the predictive efficacy of the platelet-albumin-bilirubin (PALBI) score for mortality in patients having transcatheter aortic valve replacement (TAVR), as well as its significance for enhancing risk classification alongside the Society of Thoracic Surgeons (STS) score. Although the research provides significant insights, some aspects demand further consideration and discussion.

First of all, this study only used the PALBI score, which includes platelet count, albumin, and bilirubin, in assessing liver function in TAVR patients. However, it did not consider other liver prognostic models, such as the Child-Pugh (CP) and Model for End-Stage Liver Disease (MELD) scores, which involve biomarkers such as creatinine and INR. A multicenter study found that using various hepatic prognostic models can improve outcome prediction in TAVR patients [2].

Additionally, this investigation excluded significant comorbidities that have reduced the PALBI score's predictive validity, including frailty, systemic inflammation, malnutrition, and anticoagulant treatment. These factors significantly affect albumin and platelet counts, which could reduce PALBI's precision as a predictor. By incorporating these variables into multivariate models, PALBI's feasibility as an independent predictor of TAVR-related mortality would be strengthened. The 2018 study found that comorbid conditions like malnutrition significantly affect TAVR outcomes. In TAVR patients, low serum albumin, a gauge of both malnutrition and frailty, has been associated with a higher 30-day mortality rate and more postoperative complications [3].

Furthermore, the PALBI score may not provide a complete risk assessment for patients undergoing TAVR because it does not account for key cardiac-specific factors such as left ventricular ejection fraction (LVEF), aortic valve gradient (AVG), or the presence of coronary artery disease. Relying only on the PALBI score ignoring these key cardiac characteristics may result in an inadequate assessment of patient risk, thus limiting its predictive accuracy in TAVR populations. Reduced LVEF and low AVG are substantially related with poor post-TAVR outcomes, with low AVG providing as a significant predictor of mortality [4].

This study does not include people with chronic liver illness, end-stage renal disease (ESRD), and dialysis, limiting its credibility. These high-risk patients typically have poor post-TAVR outcomes, their exclusion may underestimate PALBI's true prognostic value in real-world circumstances. Chronic kidney disease (CKD) and ESRD have a considerable impact on TAVR outcomes, with studies indicating that dialysis-dependent patients have higher mortality rates and a higher 1-year mortality than non-dialysis patients [5]. Including these patients in future study would allow for a more thorough assessment of PALBI's prediction accuracy across a wide spectrum of TAVR groups.

In spite of these limitations, the study offers a useful viewpoint on the PALBI score's predictive function in TAVR risk comparison. Validation of its therapeutic relevance requires future studies with bigger, multi-center cohorts, thorough risk modeling, and inclusion of high-risk individuals. The authors' efforts to improve risk stratification in TAVR patients are much appreciated.

The authors declare no conflicts of interest.

血小板-白蛋白-胆红素评分对经导管主动脉瓣置换术患者的预后价值
我们怀着极大的兴趣阅读了《血小板-白蛋白-胆红素评分对经导管主动脉瓣置换术患者的预后价值》一文。,作者:Duan等。阅读这样一部写得很好的完整的作品是令人满意的,作者在这个重要主题上的努力必须得到承认。本研究全面评估了血小板-白蛋白-胆红素(PALBI)评分对经导管主动脉瓣置换术(TAVR)患者死亡率的预测效果,以及PALBI评分与胸外科学会(STS)评分一起提高风险分级的意义。虽然这项研究提供了重要的见解,但有些方面需要进一步的考虑和讨论。首先,本研究仅使用PALBI评分来评估TAVR患者的肝功能,PALBI评分包括血小板计数、白蛋白和胆红素。然而,它没有考虑其他肝脏预后模型,如Child-Pugh (CP)和终末期肝病模型(MELD)评分,这些模型涉及肌酐和INR等生物标志物。一项多中心研究发现,使用多种肝脏预后模型可以改善TAVR患者的预后预测。此外,该研究排除了降低PALBI评分预测有效性的显著合并症,包括虚弱、全身性炎症、营养不良和抗凝治疗。这些因素显著影响白蛋白和血小板计数,这可能降低PALBI作为预测指标的准确性。通过将这些变量纳入多变量模型,PALBI作为tavr相关死亡率独立预测因子的可行性将得到加强。2018年的研究发现,营养不良等共病会显著影响TAVR的结果。在TAVR患者中,低血清白蛋白(一种营养不良和虚弱的指标)与较高的30天死亡率和更多的术后并发症相关。此外,PALBI评分可能不能为接受TAVR的患者提供完整的风险评估,因为它没有考虑到关键的心脏特异性因素,如左室射血分数(LVEF)、主动脉瓣梯度(AVG)或冠状动脉疾病的存在。仅依赖PALBI评分,忽视这些关键的心脏特征可能导致对患者风险的评估不充分,从而限制了其在TAVR人群中的预测准确性。低LVEF和低AVG与tavr后的不良预后有很大关系,低AVG是死亡率的重要预测因子。本研究不包括慢性肝病、终末期肾病(ESRD)和透析患者,限制了其可信度。这些高危患者通常tavr后预后较差,排除他们可能低估了PALBI在现实情况下的真实预后价值。慢性肾脏疾病(CKD)和ESRD对TAVR结局有相当大的影响,研究表明透析依赖患者的死亡率和1年死亡率高于非透析患者bbb。将这些患者纳入未来的研究将允许对PALBI在广泛的TAVR组中的预测准确性进行更彻底的评估。尽管存在这些局限性,该研究为PALBI评分在TAVR风险比较中的预测功能提供了一个有用的观点。验证其治疗相关性需要未来更大的多中心队列研究,全面的风险建模,并纳入高风险个体。作者为改善TAVR患者的风险分层所做的努力是值得赞赏的。作者声明无利益冲突。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Clinical Cardiology
Clinical Cardiology 医学-心血管系统
CiteScore
5.10
自引率
3.70%
发文量
189
审稿时长
4-8 weeks
期刊介绍: Clinical Cardiology provides a fully Gold Open Access forum for the publication of original clinical research, as well as brief reviews of diagnostic and therapeutic issues in cardiovascular medicine and cardiovascular surgery. The journal includes Clinical Investigations, Reviews, free standing editorials and commentaries, and bonus online-only content. The journal also publishes supplements, Expert Panel Discussions, sponsored clinical Reviews, Trial Designs, and Quality and Outcomes.
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