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Implication of modified MELD scores for postdischarge prognosis in hospitalized patients with heart failure

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Abstract

We evaluated whether modified Model for End-Stage Liver Disease (MELD) scores are useful for predicting the postdischarge prognosis in hospitalized patients with heart failure (HF) who are discharged alive. The MELD-XI and MELD-Na scores were calculated at discharge for a total of 1156 patients in the HIJ-HF II study. We also studied 3 groups on the basis of the left ventricular ejection fraction (LVEF): the HFrEF (LVEF < 40%), HFmrEF (LVEF 40–49%) and HFpEF (LVEF ≥ 50%) groups. The primary outcome was all-cause mortality, and the secondary outcome was rehospitalization due to worsening HF. The median MELD-XI and MELD-Na scores were 12 and 14, respectively. After a median follow-up of 19 months, there were significantly higher rates of all-cause mortality in patients with MELD-XI scores ≥ 12 than in those with MELD-XI scores < 12; there were also higher rates of all-cause mortality in patients with MELD-Na scores ≥ 14 than in those with MELD-Na scores < 14 (both log-rank p < 0.001). The cumulative incidence function based on a competing risks model showed a higher rate of rehospitalization due to worsening HF in patients with MELD-XI scores ≥ 12 than in those with MELD-XI scores < 12 and a higher rate of rehospitalization due to worsening HF in those with MELD-Na scores ≥ 14 than in those with MELD-Na scores < 14 (both Gray’s test p < 0.001). The adjusted hazard ratios (HRs) of all-cause mortality for patients with MELD-XI scores ≥ 12 and those with MELD-Na scores ≥ 14 were 2.07 [95% confidence interval (CI) 1.25–3.44] and 2.79 [95% CI 1.63–4.79], respectively, in the HFrEF group; however, the HRs were not significant in the HFmrEF or HFpEF groups. Thus, MELD-XI and MELD-Na scores may be useful for predicting prognosis in hospitalized HF patients who are discharged alive, especially for those in the HFrEF group.

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Acknowledgements

We thank Ms. Emi Sawada and Ms. Satsuki Sato for their assistance. This work was supported by the Japan Agency for Medical Research and Development Grant [grant number 15ek0210009h0003].

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Authors and Affiliations

  1. Department of Cardiology, Tokyo Women’s Medical University, Tokyo, Japan

    Masayuki Gotou, Atsushi Suzuki, Tsuyoshi Shiga, Noriko Kikuchi & Nobuhisa Hagiwara

  2. Department of Clinical Pharmacology and Therapeutics, The Jikei University School of Medicine, 3-25-8 Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan

    Tsuyoshi Shiga

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  1. Masayuki Gotou
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  2. Atsushi Suzuki
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  3. Tsuyoshi Shiga
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Correspondence to Tsuyoshi Shiga.

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Conflict of interest

Dr. Shiga received lecture fees and research funding from Daiichi-Sankyo. Dr. Hagiwara received research funding from Eisai, Nippon Boehringer Ingelheim and Daiichi-Sankyo and received lecture fees from Nippon Boehringer Ingelheim and Bristol-Myers Squibb. The other authors have nothing to disclose.

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Gotou, M., Suzuki, A., Shiga, T. et al. Implication of modified MELD scores for postdischarge prognosis in hospitalized patients with heart failure. Heart Vessels 38, 535–542 (2023). https://doi.org/10.1007/s00380-022-02202-z

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  • DOI: https://doi.org/10.1007/s00380-022-02202-z

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