Τίτλος:
Hepatorenal dysfunction identifies high-risk patients with acute heart failure: insights from the RELAX-AHF trial
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
Aims: Episodes of acute heart failure (AHF) may lead to end-organ dysfunction. In this post hoc analysis of the Relaxin in Acute Heart Failure trial, we used the MELD-XI (Model of End-Stage Liver Dysfunction) score to examine hepatorenal dysfunction in patients with AHF. Methods and results: On admission, the MELD-XI score was elevated (abnormal) in 918 (82%) patients, with 638 (57%) having isolated renal dysfunction (creatinine > 1 mg/dL), 73 (6.5%) isolated liver dysfunction (bilirubin > 1 mg/dL), and 207 (18.5%) coexisting dysfunction of the kidneys and the liver (both creatinine and bilirubin > 1 mg/dL). The percentage of patients with elevated MELD-XI score remained constant through a 60 day follow-up, as we observed a gradual decrease of liver dysfunction prevalence, counterbalanced by an increase in renal dysfunction. Serelaxin treatment was associated with a lower MELD-XI score on Day 2 and Day 5 (both P < 0.05), but this difference vs. placebo disappeared during longer follow-up. In the multivariable model, an elevated MELD-XI score on admission was associated with higher 180 day mortality: hazard ratios (95% confidence interval) for cardiovascular death were 3.10 (1.22–7.87), and for all-cause death 2.47 (1.19–5.15); both P < 0.05. The addition of the MELD-XI score to a prespecified prognostic model increased the discrimination of the model for all-cause death, but the increment in the C-index was only modest: 0.013 (P = 0.02). Conclusions: In patients with AHF, hepatorenal dysfunction is prevalent and related to poor outcome. The MELD-XI score is a useful prognosticator in AHF. © 2019 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology.
Συγγραφείς:
Biegus, J.
Demissei, B.
Postmus, D.
Cotter, G.
Davison, B.A.
Felker, G.M.
Filippatos, G.
Gimpelewicz, C.
Greenberg, B.
Metra, M.
Severin, T.
Teerlink, J.R.
Voors, A.A.
Ponikowski, P.
Περιοδικό:
ESC Heart Failure
Λέξεις-κλειδιά:
bilirubin; creatinine; placebo; serelaxin; bilirubin; creatinine, acute heart failure; aged; all cause mortality; Article; cardiovascular mortality; female; follow up; hepatorenal syndrome; high risk patient; human; kidney dysfunction; liver dysfunction; major clinical study; male; Model For End Stage Liver Disease Score; priority journal; prognosis; risk factor; acute disease; blood; complication; controlled study; heart failure; kidney disease; liver disease; middle aged; mortality; prognosis; randomized controlled trial; severity of illness index; very elderly, Acute Disease; Aged; Aged, 80 and over; Bilirubin; Creatinine; Female; Heart Failure; Humans; Kidney Diseases; Liver Diseases; Male; Middle Aged; Prognosis; Severity of Illness Index
