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 normalized
ratio (MELD-XI) score, in adults with CHD.
Methods
Retrospective study of CHD patients with comprehensive metabolic panel (2003-2019).
Mild/moderate and severe hepatorenal dysfunction were defined as MELD-XI 11-15 and
>15 respectively.
Results
Of 4,977 patients, 1,376 (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, 1.21-1.33, p<0.001) after adjustment for age, sex, and
congenital heart lesion.
In 3,864 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, 1.15-1.36 per
unit increase in MELD-XI, p=0.004), independent of baseline MELD-XI score. In the
subset of 1,856 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, 0.90-0.98 per unit decrease in MELD-XI, p=0.008), independent
of 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 score were associated with clinical outcomes, and
hence could be used to monitor for deterioration in clinical status, and therapeutic
response to interventions.
Key Words
Abbreviations:
CHD (congenital heart disease), RA (right atrium), RV (right ventricle), MELD-XI (model for end-stage liver disease excluding international normalized ratio), AUC (area under the curve), HR (hazard ratio), CI (confidence interval)To read this article in full you will need to make a payment
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Article Info
Publication History
Accepted:
July 26,
2022
Received in revised form:
July 11,
2022
Received:
May 19,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
Conflict of Interest: none
Disclosures: none
BRIEF SUMMARY
Of 4,977 patients, 1,376 (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%). Both baseline MELD-XI score and temporal changes in MELD-XI score were associated with clinical outcomes, and hence could be used to monitor for deterioration in clinical status, and therapeutic response to interventions.
Identification
Copyright
© 2022 Published by Elsevier Inc. on behalf of the Canadian Cardiovascular Society.
