Hepatorenal dysfunction identifies high‐risk patients with acute heart failure: insights from the RELAX‐AHF trial
Abstract 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...
| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2019-12-01
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| Series: | ESC Heart Failure |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/ehf2.12477 |
| _version_ | 1818012631557996544 |
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| author | Jan Biegus Biniyam Demissei Douwe Postmus Gad Cotter Beth A. Davison G. Michael Felker Gerasimos Filippatos Claudio Gimpelewicz Barry Greenberg Marco Metra Thomas Severin John R. Teerlink Adriaan A. Voors Piotr Ponikowski |
| author_facet | Jan Biegus Biniyam Demissei Douwe Postmus Gad Cotter Beth A. Davison G. Michael Felker Gerasimos Filippatos Claudio Gimpelewicz Barry Greenberg Marco Metra Thomas Severin John R. Teerlink Adriaan A. Voors Piotr Ponikowski |
| author_sort | Jan Biegus |
| collection | DOAJ |
| description | Abstract 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. |
| first_indexed | 2024-04-14T06:22:25Z |
| format | Article |
| id | doaj.art-7c580ac554664da0ac31cd793ebef848 |
| institution | Directory Open Access Journal |
| issn | 2055-5822 |
| language | English |
| last_indexed | 2024-04-14T06:22:25Z |
| publishDate | 2019-12-01 |
| publisher | Wiley |
| record_format | Article |
| series | ESC Heart Failure |
| spelling | doaj.art-7c580ac554664da0ac31cd793ebef8482022-12-22T02:07:58ZengWileyESC Heart Failure2055-58222019-12-01661188119810.1002/ehf2.12477Hepatorenal dysfunction identifies high‐risk patients with acute heart failure: insights from the RELAX‐AHF trialJan Biegus0Biniyam Demissei1Douwe Postmus2Gad Cotter3Beth A. Davison4G. Michael Felker5Gerasimos Filippatos6Claudio Gimpelewicz7Barry Greenberg8Marco Metra9Thomas Severin10John R. Teerlink11Adriaan A. Voors12Piotr Ponikowski13Department of Heart Diseases Wroclaw Medical University Wroclaw PolandDepartment of Epidemiology, University of Groningen University Medical Center Groningen Groningen The NetherlandsDepartment of Epidemiology, University of Groningen University Medical Center Groningen Groningen The NetherlandsMomentum Research, Inc. Durham NC USAMomentum Research, Inc. Durham NC USADuke Clinical Research Institute Durham NC USASchool of Medicine University of Cyprus Nicosia CyprusNovartis Pharma AG Basel SwitzerlandUniversity of California at San Diego San Diego CA USAInstitute of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health University of Brescia Brescia ItalyNovartis Pharmaceuticals Corporation New Hanover NJ USASection of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine University of California San Francisco San Francisco CA USADepartment of Epidemiology, University of Groningen University Medical Center Groningen Groningen The NetherlandsDepartment of Heart Diseases Wroclaw Medical University Wroclaw PolandAbstract 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.https://doi.org/10.1002/ehf2.12477Acute heart failureLiver dysfunctionKidney dysfunctionPrognosisMELD‐XI score |
| spellingShingle | Jan Biegus Biniyam Demissei Douwe Postmus Gad Cotter Beth A. Davison G. Michael Felker Gerasimos Filippatos Claudio Gimpelewicz Barry Greenberg Marco Metra Thomas Severin John R. Teerlink Adriaan A. Voors Piotr Ponikowski Hepatorenal dysfunction identifies high‐risk patients with acute heart failure: insights from the RELAX‐AHF trial ESC Heart Failure Acute heart failure Liver dysfunction Kidney dysfunction Prognosis MELD‐XI score |
| title | Hepatorenal dysfunction identifies high‐risk patients with acute heart failure: insights from the RELAX‐AHF trial |
| title_full | Hepatorenal dysfunction identifies high‐risk patients with acute heart failure: insights from the RELAX‐AHF trial |
| title_fullStr | Hepatorenal dysfunction identifies high‐risk patients with acute heart failure: insights from the RELAX‐AHF trial |
| title_full_unstemmed | Hepatorenal dysfunction identifies high‐risk patients with acute heart failure: insights from the RELAX‐AHF trial |
| title_short | Hepatorenal dysfunction identifies high‐risk patients with acute heart failure: insights from the RELAX‐AHF trial |
| title_sort | hepatorenal dysfunction identifies high risk patients with acute heart failure insights from the relax ahf trial |
| topic | Acute heart failure Liver dysfunction Kidney dysfunction Prognosis MELD‐XI score |
| url | https://doi.org/10.1002/ehf2.12477 |
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