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Internal and Emergency Medicine

, Volume 12, Issue 1, pp 23–30 | Cite as

Liver dysfunction as predictor of prognosis in patients with amyloidosis: utility of the Model for End-stage Liver disease (MELD) scoring system

  • Francesco CappelliEmail author
  • Samuele Baldasseroni
  • Franco Bergesio
  • Valentina Spini
  • Alessia Fabbri
  • Paola Angelotti
  • Elisa Grifoni
  • Paola Attanà
  • Francesca Tarantini
  • Niccolò Marchionni
  • Alberto Moggi Pignone
  • Federico Perfetto
IM - ORIGINAL

Abstract

Amyloidosis prognosis is often related to the onset of heart failure and a worsening that is concomitant with kidney–liver dysfunction; thus the Model for End-stage Liver disease (MELD) may be an ideal instrument to summarize renal–liver function. Our aim has been to test the MELD score as a prognostic tool in amyloidosis. We evaluated 128 patients, 46 with TTR-related amyloidosis and 82 with AL amyloidosis. All patients had a complete clinical and echocardiography evaluation; overall biohumoral assessment included troponin I, NT-proBNP, creatinine, total bilirubin and INR ratio. The study population was dichotomized at the 12 cut-off level of MELD scores; those with MELD score >12 had a lower survival compared to controls in the study cohort (40.7 vs 66.3 %; p = 0.006). Either as a continuous and dichotomized variable, MELD shows its independent prognostic value at multivariable analysis (HR = 1.199, 95 % CI 1.082–1.329; HR = 2.707, 95 % CI 1.075–6.817, respectively). MELD shows a lower prognostic sensitivity/specificity ratio than troponin I and NT-proBNP in the whole study population and AL subgroup, while in TTR patients MELD has a higher sensitivity/specificity ratio compared to troponin and NT-proBNP (ROC analysis-AUC: 0.853 vs 0.726 vs 0.659). MELD is able to predict prognosis in amyloidosis. A MELD score >12 selects a subgroup of patients with a higher risk of death. The predictive accuracy seems to be more evident in TTR patients in whom currently no effective scoring systems have been validated.

Keywords

Amyloid Prognosis MELD Liver dysfunction 

Notes

Compliance with ethical standards

Conflict of interest

None.

Statement of human and animal rights

For this type of study formal consent is not required.

Informed consent

All patients gave written informed consent for their clinical records to be used for research purposes, in accordance with Institutional Review Board guidelines.

Supplementary material

11739_2016_1500_MOESM1_ESM.jpg (26 kb)
Supplementary material 1 Figure 1: Survival curves (KM) according to MELD score cut-off. (JPEG 25 kb)
11739_2016_1500_MOESM2_ESM.jpg (29 kb)
Supplementary material 2 Figure  2: Survival curves (KM) according to MELD score cut-off in the two amyloidosis etiologies. (JPEG 29 kb)

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Copyright information

© SIMI 2016

Authors and Affiliations

  • Francesco Cappelli
    • 1
    • 3
    Email author
  • Samuele Baldasseroni
    • 1
    • 2
  • Franco Bergesio
    • 3
  • Valentina Spini
    • 1
  • Alessia Fabbri
    • 5
  • Paola Angelotti
    • 5
  • Elisa Grifoni
    • 4
  • Paola Attanà
    • 4
  • Francesca Tarantini
    • 2
  • Niccolò Marchionni
    • 2
  • Alberto Moggi Pignone
    • 4
  • Federico Perfetto
    • 3
    • 4
  1. 1.Intensive Cardiac Unit, Department of Heart and VesselsUniversity of Florence and Azienda Ospedaliero-Universitaria Careggi [AOUC]FlorenceItaly
  2. 2.Research Unit of Medicine of Aging, Department of Experimental and Clinical MedicineUniversity of FlorenceFlorenceItaly
  3. 3.Regional Amyloid CentreAzienda Ospedaliero-Universitaria CareggiFlorenceItaly
  4. 4.Department of Internal MedicineUniversity of FlorenceFlorenceItaly
  5. 5.Department of Heart and VesselsUniversity of FlorenceFlorenceItaly

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