MELD-XI score is not associated with adverse outcomes in ambulatory adults with a Fontan circulation
Background: The Model for End-stage Liver Disease excluding INR (MELD-XI) is commonly used to identify patients with a Fontan circulation at increased risk of adverse events, However, this approach has not been evaluated in unselected ambulatory adults. Methods: We enrolled a cohort of 163 outpatien...
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Format: | Article |
Language: | English |
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Elsevier
2021-08-01
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Series: | International Journal of Cardiology Congenital Heart Disease |
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Online Access: | http://www.sciencedirect.com/science/article/pii/S2666668521001063 |
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doaj-250a3f08c74240b995f565fb186a8746 |
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record_format |
Article |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Nael Aldweib Chen Wei Adam M. Lubert Fred Wu Anne Marie Valente Tarek Alsaied Gabriele Egidy Assenza Felicia Eichelbrenner Joseph J. Palermo Michael J. Landzberg Valeria Duarte Alexander R. Opotowsky |
spellingShingle |
Nael Aldweib Chen Wei Adam M. Lubert Fred Wu Anne Marie Valente Tarek Alsaied Gabriele Egidy Assenza Felicia Eichelbrenner Joseph J. Palermo Michael J. Landzberg Valeria Duarte Alexander R. Opotowsky MELD-XI score is not associated with adverse outcomes in ambulatory adults with a Fontan circulation International Journal of Cardiology Congenital Heart Disease Fontan Adult congenital heart disease Single ventricle Model for end-stage liver disease excluding INR score (MELD-XI) |
author_facet |
Nael Aldweib Chen Wei Adam M. Lubert Fred Wu Anne Marie Valente Tarek Alsaied Gabriele Egidy Assenza Felicia Eichelbrenner Joseph J. Palermo Michael J. Landzberg Valeria Duarte Alexander R. Opotowsky |
author_sort |
Nael Aldweib |
title |
MELD-XI score is not associated with adverse outcomes in ambulatory adults with a Fontan circulation |
title_short |
MELD-XI score is not associated with adverse outcomes in ambulatory adults with a Fontan circulation |
title_full |
MELD-XI score is not associated with adverse outcomes in ambulatory adults with a Fontan circulation |
title_fullStr |
MELD-XI score is not associated with adverse outcomes in ambulatory adults with a Fontan circulation |
title_full_unstemmed |
MELD-XI score is not associated with adverse outcomes in ambulatory adults with a Fontan circulation |
title_sort |
meld-xi score is not associated with adverse outcomes in ambulatory adults with a fontan circulation |
publisher |
Elsevier |
series |
International Journal of Cardiology Congenital Heart Disease |
issn |
2666-6685 |
publishDate |
2021-08-01 |
description |
Background: The Model for End-stage Liver Disease excluding INR (MELD-XI) is commonly used to identify patients with a Fontan circulation at increased risk of adverse events, However, this approach has not been evaluated in unselected ambulatory adults. Methods: We enrolled a cohort of 163 outpatients with a Fontan circulation aged ≥18-years in the Boston Adult Congenital Heart Disease Biobank from 2012 to 2018. Survival analysis was performed to assess the relationship between MELD-XI with both all-cause mortality and a composite outcome of mortality or non-elective cardiovascular hospitalization. Results: Mean age was 30.2±9.7 years, and 41.1% were women. Most had a lateral tunnel Fontan (62.6%). MELD-XI score averaged 10.6±2.1 (median = 13). Both creatinine and total bilirubin were ≤1.0 mg/dL in 94/163 (57.7%), translating to the lowest possible score. MELD-XI<11 was present in 123 patients (75.5%), while only 3 (1.8%) had MELD-XI>18. During follow-up of 3.2±2.2 years, the composite outcome occurred in 58 patients (35.6%), with 16 deaths (9.8%). Most deaths (n = 11, 68.8%) and composite outcomes (n = 39, 67.2%) occurred among patients with MELD-XI less than the median. MELD-XI score did not differ between those who did and did not have events (death: 10.8±2.2 vs. 10.6±2.1; p = 0.92; composite outcome: 10.6±2.2 vs. 10.7±2.1, p = 0.45). Likewise, survival analysis did not suggest an association between MELD-XI and either outcome. Conclusions: MELD-XI score does not appear to be associated with risk for adverse outcomes in an unselected cohort of outpatients with a Fontan circulation. Prior findings may reflect conditioning on a clinical referral for laboratory testing. |
topic |
Fontan Adult congenital heart disease Single ventricle Model for end-stage liver disease excluding INR score (MELD-XI) |
url |
http://www.sciencedirect.com/science/article/pii/S2666668521001063 |
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doaj-250a3f08c74240b995f565fb186a87462021-09-01T04:23:13ZengElsevierInternational Journal of Cardiology Congenital Heart Disease2666-66852021-08-014100182MELD-XI score is not associated with adverse outcomes in ambulatory adults with a Fontan circulationNael Aldweib0Chen Wei1Adam M. Lubert2Fred Wu3Anne Marie Valente4Tarek Alsaied5Gabriele Egidy Assenza6Felicia Eichelbrenner7Joseph J. Palermo8Michael J. Landzberg9Valeria Duarte10Alexander R. Opotowsky11Department of Cardiology, Boston Children's Hospital, Boston, MA, United States; Department of Medicine, Brigham and Women's Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United StatesHarvard Medical School, Boston, MA, United StatesHeart Institute, Department of Pediatrics, Cincinnati Children's Hospital, University of Cincinnati College of Medicine, Cincinnati, OH, United StatesDepartment of Cardiology, Boston Children's Hospital, Boston, MA, United States; Department of Medicine, Brigham and Women's Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United StatesDepartment of Cardiology, Boston Children's Hospital, Boston, MA, United States; Department of Medicine, Brigham and Women's Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United StatesHeart Institute, Department of Pediatrics, Cincinnati Children's Hospital, University of Cincinnati College of Medicine, Cincinnati, OH, United StatesDepartment of Cardiovascular Medicine, Pediatric Cardiology, and Adult Congenital Heart Disease Program, Azienda Ospedaliera-Universitaria Sant'Orsola-Malpighi Hospital, Alma Mater Studiorum Medical School, Bologna, ItalyHeart Institute, Department of Pediatrics, Cincinnati Children's Hospital, University of Cincinnati College of Medicine, Cincinnati, OH, United StatesDivision of Gastroenterology, Hepatology, and Nutrition, Cincinnati Children's Hospital, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United StatesDepartment of Cardiology, Boston Children's Hospital, Boston, MA, United States; Department of Medicine, Brigham and Women's Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United StatesDepartment of Cardiology, Boston Children's Hospital, Boston, MA, United States; Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, United StatesDepartment of Cardiology, Boston Children's Hospital, Boston, MA, United States; Department of Medicine, Brigham and Women's Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States; Heart Institute, Department of Pediatrics, Cincinnati Children's Hospital, University of Cincinnati College of Medicine, Cincinnati, OH, United States; Corresponding author. Cincinnati Adult Congenital Heart Disease Program, Heart Institute, Cincinnati Children's Hospital, 3333 Burnet Avenue, MLC 2003 Cincinnati, OH, 45229, United States.Background: The Model for End-stage Liver Disease excluding INR (MELD-XI) is commonly used to identify patients with a Fontan circulation at increased risk of adverse events, However, this approach has not been evaluated in unselected ambulatory adults. Methods: We enrolled a cohort of 163 outpatients with a Fontan circulation aged ≥18-years in the Boston Adult Congenital Heart Disease Biobank from 2012 to 2018. Survival analysis was performed to assess the relationship between MELD-XI with both all-cause mortality and a composite outcome of mortality or non-elective cardiovascular hospitalization. Results: Mean age was 30.2±9.7 years, and 41.1% were women. Most had a lateral tunnel Fontan (62.6%). MELD-XI score averaged 10.6±2.1 (median = 13). Both creatinine and total bilirubin were ≤1.0 mg/dL in 94/163 (57.7%), translating to the lowest possible score. MELD-XI<11 was present in 123 patients (75.5%), while only 3 (1.8%) had MELD-XI>18. During follow-up of 3.2±2.2 years, the composite outcome occurred in 58 patients (35.6%), with 16 deaths (9.8%). Most deaths (n = 11, 68.8%) and composite outcomes (n = 39, 67.2%) occurred among patients with MELD-XI less than the median. MELD-XI score did not differ between those who did and did not have events (death: 10.8±2.2 vs. 10.6±2.1; p = 0.92; composite outcome: 10.6±2.2 vs. 10.7±2.1, p = 0.45). Likewise, survival analysis did not suggest an association between MELD-XI and either outcome. Conclusions: MELD-XI score does not appear to be associated with risk for adverse outcomes in an unselected cohort of outpatients with a Fontan circulation. Prior findings may reflect conditioning on a clinical referral for laboratory testing.http://www.sciencedirect.com/science/article/pii/S2666668521001063FontanAdult congenital heart diseaseSingle ventricleModel for end-stage liver disease excluding INR score (MELD-XI) |