The Liver Knows: Preoperative MELD Score as a Predictor of Outcome in Patients Undergoing Left Ventricular Assist Device Implantation. A Single-Center Retrospective Cohort Study

IF 2.1 Q2 MEDICINE, GENERAL & INTERNAL

Health Science Reports Pub Date : 2025-07-23 DOI:10.1002/hsr2.71071

Mohamed Elbayomi, Presheet Pathare, Raphael Groß, Friedrich Mellert, Oliver Dewald

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Abstract

Background and Aims

Right-side heart failure (RSHF) jeopardizes left ventricular assist device (LVAD) short- and long-term outcomes. The model for end-stage liver disease (MELD) score is an effective means of evaluating liver dysfunction. This study aims to investigate the predictive utility of preoperative MELD on post-LVAD implantation outcomes, specifically focusing on the incidence of RSHF.

Methods

This single-center retrospective cohort study included 133 patients who received durable continuous-flow LVADs with a centrifugal pump from 2015 to 2022. The primary outcome was RSHF, defined as necessitating right ventricular (RV), temporary or durable, mechanical support. The research hypothesis was that a high preoperative MELD score is associated with a higher incidence of RSHF after LVAD implantation.

Results

The overall post-LVAD RSHF incidence was 18% (n = 24), and 90-day mortality was 30% (n = 40). The mean MELD score was 14.7 (±6.9). RSHF was significantly associated with in-hospital mortality (Peasrson's chi-squared = 37.86, p < 0.001). The RSHF group had a higher mean MELD score of 18.7 (±2), whereas the control group had a mean MELD score of 13.8 (±0.5). The mean MELD difference between the RSHF and non-RSHF groups was 4.75 (95% CI: 1.7–7.7), with the RSHF group having a higher mean and (18.7 ± 2, p = 0.001) compared to the control group (14 ± 0.5, p = 0.002). The incidence of RSHF did not statistically differ between INTERMACS groups (p = 0.35). Preoperative MELD score was an independent predictor of RSHF in a multivariable logistic regression model, including age, EuroSCORE-2, and INTERMACS categories (OR 1.08; 95% CI: 1.02–1.15; p = 0.009).

Conclusion

Preoperative MELD score may predict the incidence of postoperative RSHF in LVAD patients. Candidates with elevated MELD scores should be carefully evaluated for alternative therapeutic modalities or optimized aggressively before LVAD implantation.

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肝脏知道：术前MELD评分作为左心室辅助装置植入患者预后的预测因子。单中心回顾性队列研究

背景和目的右侧心力衰竭（RSHF）危及左心室辅助装置（LVAD）的短期和长期预后。终末期肝病（MELD）评分模型是评价肝功能障碍的有效手段。本研究旨在探讨术前MELD对lvad植入后预后的预测作用，特别关注RSHF的发生率。方法本研究为单中心回顾性队列研究，纳入2015年至2022年接受离心泵持续连续血流lvad治疗的133例患者。主要终点是RSHF，定义为需要右心室（RV），临时或持久的机械支持。研究假设术前MELD评分高与LVAD植入后RSHF发生率高相关。结果lvad后RSHF总发生率为18% (n = 24)， 90天死亡率为30% （n = 40）。平均MELD评分为14.7（±6.9）分。RSHF与住院死亡率显著相关（peasson’s卡方= 37.86,p < 0.001）。RSHF组MELD平均评分为18.7（±2）分，而对照组MELD平均评分为13.8（±0.5）分。RSHF组与非RSHF组的平均MELD差异为4.75 (95% CI: 1.7-7.7)， RSHF组的平均值（18.7±2,p = 0.001）高于对照组（14±0.5,p = 0.002）。两组间RSHF发生率无统计学差异（p = 0.35）。在包括年龄、EuroSCORE-2和INTERMACS分类在内的多变量logistic回归模型中，术前MELD评分是RSHF的独立预测因子(OR 1.08；95% ci: 1.02-1.15；p = 0.009)。结论术前MELD评分可预测LVAD患者术后RSHF的发生。MELD评分较高的候选人应仔细评估替代治疗方式或在LVAD植入前积极优化。

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