Abstract

Background: The demographic profile of heart failure (HF) is important to understand for its effective management and liver dysfunction has got prognostic impact on its outcome. We aimed to look for the demographic profile of HF and find out the predictive role of model for end-stage liver disease-XI (MELDXI) score such that its prognostic implications in HF could be determined in the western Nepal.

Methods: Among 264 consecutive hospitalized HF patients, demographic profile was recorded prospectively and the patients were followed up till 3 months with recording of the composite end-points, which were defined as adverse outcomes measured in terms of all-cause death and hospital re-admission. The MELD-XI score was calculated as 11.76 (loge creatinine)+5.112 (loge total bilirubin)+9.44 and its predictive role in the adverse outcomes in HF was determined.

Results: Among 264 patients, the causes of HF were ischemic (29.5%), hypertensive (24.6%), dilated cardiomyopathy (21.6%), cor-pulmonale (15.5%) and valvular (8.7%), and 27.7% patients had adverse outcomes (re-admission 20.1% and all-cause death 7.6%). The prevalence of history of hypertension and diabetes in HF was 54.2% and 14.8%, respectively. The overall mean MELD-XI score was 10.8 (±2.1; range 6.3-18.8); the mean score was <10 in patients with no adverse outcome, >13 in patients with adverse outcome and >15 in patients who died. In univariate analysis, the MELD-XI score was found to be a significant predictor of adverse outcomes in HF with adjusted R² of 0.928 (P<0.001). The logistic regression analysis showed that the adverse outcome of HF could be predicted by the combination of MELD-XI score, ejection fraction, New York Heart Association functional class and age (Nagelkerke’s pseudo R² 0.935) with beta coefficient of MELD-XI being 3.79 (p<0.001) and that of ejection fraction being -0.19 (P 0.009); the Hosmer-Lemshow test showed p value of 1.0 (chi-square value of 0.494) indicating the goodness of fit for our logistic regression model. The area under receiver operating curve of MELD-XI score for adverse outcomes in HF was 0.993 (P<0.001).

Conclusion: Ischemic and hypertensive heart diseases were the common causes of HF in western region of Nepal. The MELD-XI score was an excellent predictor of hospital re-admission and all-cause death in the patients of HF and could be an important prognostic tool in the patients of HF. Further study with a large sample is required to establish the predictive role of increased MELD-XI score on adverse outcome of HF.

Keywords: Predictor, MELD-XI score, heart failure, Nepal