Prognostic value of model for end-stage liver disease excluding international normalized ratio score combined with late gadolinium enhancement in heart failure with reduced ejection fraction

Abstract

Introduction Heart failure with reduced ejection fraction (HFrEF) is one of the main subtypes of heart failure (HF). Model for end-stage liver disease excluding international normalized ratio (MELD-XI) score and late gadolinium enhancement (LGE) assessed by cardiac magnetic resonance (CMR) each independently predict adverse prognosis in HF patients. Methods This retrospective study enrolled adult HFrEF patients admitted to Qilu Hospital of Shandong University between September 2018 and January 2023. The primary endpoint was defined as a composite endpoint of rehospitalization for HF and all-cause mortality. Multivariate Cox regression model was established to evaluate the effects of LGE and MELD-XI score on the primary endpoint. We also evaluate the incremental prognostic value of adding the MELD-XI score to the model. Results A total of 246 HFrEF patients were included and 55 patients reached the primary endpoint during follow-up. In the adjusted Cox regression model, for each standard deviation increase in LGE and MELD-XI score, the hazard ratios (HRs) for primary endpoint were 1.52 (95% CI: 1.23–1.88) and 1.60 (95% CI: 1.31–1.94), respectively. Adding MELD-XI score into model improved its incremental prognostic performance [ Δ C-Statistic: 0.052 (95% CI: 0.001–0.092), p = 0.039; Continuous NRI: 0.399 (95% CI: 0.077–0.532), p = 0.027; IDI: 0.094 (95% CI: 0.018–0.174), p = 0.010]. Conclusions Both CMR-assessed LGE and MELD-XI score were associated with adverse outcomes in patients with HFrEF. Combining these two indicators provided complementary prognostic information for HFrEF patients.