Model for End-Stage Liver Disease incorporating albumin score is associated with short- and long-term all-cause mortality in patients with acute myocardial infarction complicated by cardiogenic shock.

Background: Liver injury is a frequent complication in patients with acute myocardial infarction complicated by cardiogenic shock (AMICS). The Model for End-Stage Liver Disease incorporating albumin (MELD-albumin) quantifies liver injury. This study assesses the association between MELD-albumin score and all-cause mortality among patients with AMICS.

Methods and results: From a retrospective cohort of 1716 consecutive AMICS patients admitted between 2010 and 2017, we included patients who survived until day 3 and had complete laboratory data available (N=717). MELD-albumin was calculated using 0 to 72-hour peak s-bilirubin and s-creatinine values and the lowest s-albumin value. Patients were stratified into tertiles low, intermediate, and high MELD-albumin. The primary outcome was all-cause mortality with a follow-up of up to 14 years.Patients in the high score group were more often female, had lower left ventricular ejection fraction, higher lactate levels, and less suffered out-of-hospital cardiac arrest. The high score group had a significantly higher all-cause mortality rate than the intermediate and low score group at 30 days (49 vs. 35 vs. 26%, p<0.001) and 10 years for 30-day survivors (58 vs. 46 vs. 37%, p<0.001). Adjusted hazard ratios for mortality in the high score group were 2.02 at 30 days (95% CI: 1.49-2.74, p<0.001) and 1.86 at 10 years (95% CI: 1.18-2.92, p<0.001). The MELD-albumin score demonstrated an area under the receiver operating curve of 0.63 (95% CI: 0.59-0.67) for predicting 30-day mortality.

Conclusions: Liver injury, quantified as MELD-albumin score, was significantly associated with short- and long-term all-cause mortality among AMICS patients.