改良终末期肝病模型评分在心脏再同步化治疗患者中的预后价值

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Rhythm O2 Pub Date : 2025-03-01 DOI:10.1016/j.hroo.2024.12.014

Tianxin Long MD, PhD , Yu Yu MD, PhD , Sijing Cheng MD, PhD, Hao Huang MD, PhD, Wei Hua MD, PhD, FHRS

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引用次数: 0

摘要

背景：肝肾功能障碍在心力衰竭（HF）患者中普遍存在。目的：本研究探讨改良终末期肝病模型（不包括国际标准化比值[MELD-XI]评分的终末期肝病模型）和白蛋白替代国际标准化比值[MELD-Albumin]评分的终末期肝病模型)在接受心脏再同步化治疗（CRT）患者中的预后价值。方法回顾性分析365例患者(平均年龄58.7±11.1岁；64.9%的男性)在2007年至2019年期间接受了CRT植入。根据CRT前改良MELD评分四分位数分为4组。主要终点是全因死亡率和HF住院率，而次要终点是6个月时的CRT反应。结果平均随访3.3年（四分位数间隔1.9-5.2年），168例患者达到主要终点。逻辑回归显示meld -白蛋白评分与CRT疗效独立相关，即使在调整协变量后也是如此(优势比1.10；95%置信区间[CI] 1.02-1.19；P = .013)。Kaplan-Meier分析显示，MELD-XI和MELD-Albumin评分较高的患者发生不良结局的风险更高(log-rank检验：P <；措施)。Cox比例风险分析显示，在调整临床和超声心动图因素后，修改后的MELD评分仍与不良结局显著相关(MELD- xi：风险比1.06,95% CI 1.02-1.11, P = 0.006；MELD-Albumin：风险比1.10,95% CI 1.05-1.16, P <；措施)。此外，接受者操作特征分析表明，MELD-Albumin评分比MELD-XI评分(MELD-Albumin：曲线下面积0.692,95% CI 0.644-0.742；MELD-XI：曲线下面积0.659,95% CI 0.608-0.715；P = .008)。结论meld -白蛋白评分可能有助于对心衰患者进行CRT反应风险和不良结局风险的分层。

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Prognostic value of the modified Model for End-Stage Liver Disease score in patients treated with cardiac resynchronization therapy

Background

Hepatorenal dysfunction is prevalent among individuals with heart failure (HF).

OBJECTIVE

This study investigated prognostic value of the modified Model for End-Stage Liver Disease (Model for End-Stage Liver Disease excluding international normalized ratio [MELD-XI] scores and Model for End-Stage Liver Disease with albumin replacing international normalized ratio [MELD-Albumin]) score in patients undergoing cardiac resynchronization therapy (CRT).

Methods

We retrospectively evaluated 365 patients (mean age 58.7 ± 11.1 years; 64.9% men) undergoing CRT implantation between 2007 and 2019. Patients were divided into 4 groups based on the modified MELD score quartiles before CRT. The primary endpoint was the combination of all-cause mortality and HF hospitalization, whereas the secondary endpoint was CRT response at 6 months.

Results

During mean follow-up of 3.3 years (interquartile range 1.9–5.2 years), 168 patients reached the primary endpoint. Logistic regression revealed the MELD-Albumin score was independently associated with CRT response, even after adjusting for covariates (odds ratio 1.10; 95% confidence interval [CI] 1.02–1.19; P = .013). Kaplan-Meier analysis revealed that patients with a higher MELD-XI and MELD-Albumin score had a greater risk of adverse outcomes (log-rank test: P < .001). A Cox proportional hazards analysis showed that the modified MELD score remained significantly associated with adverse outcomes after adjusting for clinical and echocardiographic factors (MELD-XI: hazard ratio 1.06, 95% CI 1.02–1.11, P = .006; MELD-Albumin: hazard ratio 1.10, 95% CI 1.05–1.16, P < .001). Furthermore, receiver-operating characteristic analysis indicated that the MELD-Albumin score provided a stronger prognostic value for long-term adverse outcomes in patients undergoing CRT than the MELD-XI score (MELD-Albumin: area under the curve 0.692, 95% CI 0.644–0.742; MELD-XI: area under the curve 0.659, 95% CI 0.608–0.715; P = .008).