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.
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F. Cappelli and S. Baldasseroni equally contributed to the present manuscript.
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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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Cappelli, F., Baldasseroni, S., Bergesio, F. et al. Liver dysfunction as predictor of prognosis in patients with amyloidosis: utility of the Model for End-stage Liver disease (MELD) scoring system. Intern Emerg Med 12, 23–30 (2017). https://doi.org/10.1007/s11739-016-1500-0
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DOI: https://doi.org/10.1007/s11739-016-1500-0