Abstract
Background
There are limited data on the prognostic role of hepatorenal function indices in ambulatory
patients with congenital heart disease (CHD). The purpose of this study was to determine
the prevalence, risk factors, and prognostic implications of hepatorenal dysfunction,
as measured by Model for End-Stage Liver Disease Excluding International Normalised
Ratio (MELD-XI) score, in adults with CHD.
Methods
In this retrospective study of CHD patients with comprehensive metabolic panels (2003-2019),
mild/moderate and severe hepatorenal dysfunction was defined as MELD-XI 11-15 and
> 15, respectively.
Results
Of 4977 patients, 1376 (28%) had hepatorenal dysfunction (mild/moderate: n = 935 [19%];
severe: n = 441 [9%]). Hepatorenal dysfunction was most common in Fontan/unrepaired
single ventricle (46%) and right heart disease (31%). Baseline MELD-XI was associated
with all-cause mortality (HR 1.27, CI 1.21-1.33; P < 0.001) after adjustment for age, sex, and congenital heart lesion. In 3864 patients
with serial MELD-XI data, there was a temporal increase in MELD-XI, and this was associated
with an increased risk of mortality (HR 1.24, CI 1.15-1.36, per unit increase in MELD-XI;
P = 0.004), independently from the baseline MELD-XI score. In the subset of 1856 patients
that underwent surgical/transcatheter interventions, there was a postoperative reduction
in MELD-XI, and this was associated with a lower risk of mortality (HR 0.94, CI 0.90-0.98,
per unit decrease in MELD-XI; P = 0.008), independently from the baseline MELD-XI score.
Conclusions
Hepatorenal dysfunction was common in adults with CHD. Both baseline MELD-XI score
and temporal changes in MELD-XI were associated with clinical outcomes, and therefore
could be used to monitor therapeutic response to interventions and for deterioration
in clinical status.
Résumé
Contexte
Il existe peu de données sur le rôle des indices du fonctionnement hépatorénal dans
l’établissement du pronostic des patients ambulatoires atteints d’une cardiopathie
congénitale. L’objectif de cette étude était de déterminer la prévalence de l’insuffisance
hépatorénale, les facteurs de risque de la maladie et les facteurs pronostiques à
considérer, mesurés à l’aide du modèle d'hépatopathie en phase terminale excluant
le rapport international normalisé (MELD-XI; de l'anglais : Model for End-Stage Liver
Disease Excluding International Normalised Ratio), chez des adultes atteints d’une
cardiopathie congénitale.
Méthodologie
Dans cette étude rétrospective menée auprès de patients atteints d’une cardiopathie
congénitale ayant subi un bilan métabolique complet (2003-2019), la dysfonction hépatorénale
correspondait à un score MELD-XI de 11 à 15 pour la forme légère ou modérée et de
> 15 pour la forme grave.
Résultats
Parmi les 4 977 patients, 1 376 (28 %) présentaient une dysfonction hépatorénale (légère
ou modérée : n = 935 [19 %]; grave : n = 441 [9 %]). La dysfonction hépatorénale était
plus courante chez les personnes ayant subi une intervention de Fontan ou ayant un
ventricule unique non opéré (46 %) et chez celles présentant une insuffisance cardiaque
droite (31 %). Le score MELD-XI au départ était associé à la mortalité toutes causes
confondues (rapport de risques instantanés [RRI] : 1,27; intervalle de confiance [IC]
de 1,21 à 1,33; p < 0,001) après ajustement pour l’âge, le sexe et les lésions cardiaques congénitales.
Chez 3 864 patients pour lesquels les scores MELD-XI ont été recueillis en série,
on a observé une augmentation temporelle de ce score, ce qui était associé à un risque
accru de décès (RRI : 1,24; IC de 1,15 à 1,36, augmentation par unité du score MELD-XI;
p = 0,004), quel que soit le score au départ. Dans le sous-groupe de 1 856 patients
qui ont subi une intervention chirurgicale ou par cathéter, il y avait une réduction
postopératoire du score MELD-XI, qui était associée à un plus faible risque de décès
(RRI : 0,94; IC de 0,90 à 0,98, diminution par unité de MELD-XI; p = 0,008), quel que soit le score MELD-XI au départ.
Conclusions
La dysfonction hépatorénale était courante chez les adultes atteints d’une cardiopathie
congénitale. Tant le score MELD-XI au départ que son évolution temporelle étaient
associés à des issues cliniques et pourraient donc être utilisés pour surveiller la
réponse thérapeutique aux interventions et la détérioration de l’état clinique.
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Article Info
Publication History
Published online: August 04, 2022
Accepted:
July 26,
2022
Received:
May 19,
2022
Footnotes
See page 1749 for disclosure information.
Identification
Copyright
© 2022 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
