Prognostic value of modified model for end-stage liver disease scores in patients with significant tricuspid regurgitation
Junxing Lv, Yunqing Ye, Zhe Li, Bin Zhang, Qing‐Rong Liu, Qinghao Zhao, Zhenyan Zhao, Weiwei Wang, Haitong Zhang, Zhenya Duan, Bincheng Wang, Zikai Yu, Shuai Guo, Yanyan Zhao, Runlin Gao, Haiyan Xu, Yongjian Wu, for the CHINA-VHD Collaborators, Yongjian Wu, Haiyan Xu, Yujie Zhou, Haibo Zhang, Changfu Liu, Qing Yang, Hongliang Cong, Daxin Zhou, Xianxian Zhao, Zhihui Zhang, Xianyan Jiang, Mei Zhang, Qinghua Han, Jian An, Yong‐Sheng Ke, Lianglong Chen, Rong Lin, Jianfang Luo, Hong Wen, Wu Qiang, Wang Liao, Chuanyu Gao, Ling Li, Xiaoyong Qi, Zheng Ji, Xi Su, Xinqun Hu, Yue Li, Bo Yu, Bin Liu, Shao‐Liang Chen, Jianan Wang, Guosheng Fu, Zeqi Zheng, Zheng Zhang, Bing Song, Ping Xie, Xingsheng Zhao, Hanjun Pei, Hui Huang, Ling Tao, Fei Li, Yingqiang Guo, Zhongcai Fan, Haoyu Wang, Tao Guo, Guizhou Tao, Ming Ren, Luobu Gesang, Xiang Ma
Abstract
AIMS: Tricuspid regurgitation (TR) may cause damage to liver and kidney function. The Model for End-Stage Liver Disease excluding international normalized ratio (MELD-XI) and the model with albumin replacing international normalized ratio (MELD-Albumin) scores, which include both liver and kidney function indexes, may predict mortality in patients with TR. The study aimed to analyse the prognostic value of MELD-XI and MELD-Albumin scores in patients with significant TR. METHODS AND RESULTS: A total of 1825 patients with at least moderate pure native TR from the China Valvular Heart Disease study between April and June 2018, were included in this analysis. The primary outcome was all-cause death within 2 years. Of 1825 patients, 165 (9.0%) died during follow-up. Restricted cubic splines revealed that hazard ratio for death increased monotonically with greater modified MELD scores. The MELD-XI and MELD-Albumin scores, as continuous variables or categorized using thresholds determined by maximally selected rank statistics, were independently associated with 2-year mortality (all adjusted P < 0.001). Both scores provided incremental value over prognostic model without hepatorenal indexes {MELD-XI score: net reclassification index [95% confidence interval (95% CI), 0.237 (0.138-0.323)]; MELD-Albumin score: net reclassification index (95% CI), 0.220 (0.122-0.302)}. Results were similar in clinically meaningful subgroups, including but not limited to patients under medical treatment and those with normal left ventricular ejection fraction. Models including modified MELD scores were established for prognostic evaluation of significant TR. CONCLUSION: Both MELD-XI and MELD-Albumin scores provided incremental prognostic information and could play important roles in risk assessment in patients with significant TR.