Cardio-renal and cardio-hepatic interactions predict cardiovascular events in elderly patients with heart failure

PLoS One. 2020 Oct 23;15(10):e0241003. doi: 10.1371/journal.pone.0241003. eCollection 2020.


Background: The composite Model for End-Stage Liver Disease Excluding International Normalized Ratio Score (MELD-XI) is a novel tool to evaluate cardio-renal and cardio-hepatic interactions in patients with advanced heart failure (HF). However, its prognostic ability remains unclear in elderly HF patients.

Methods and results: From July 2014 to July 2018, patients hospitalized for HF were prospectively recruited at 16 centers. Clinical features, laboratory findings, and echocardiography results were assessed prior to discharge. Cardiovascular (CV) death and HF re-hospitalization were recorded. Of the 676 patients enrolled, 264 (39.1%) experienced CV events throughout a 1-year median follow-up period. Patients with high MELD-XI were predominantly male and had a higher prevalence of NYHA III/IV, history of HF admission, hyperuricemia, ventricular tachycardia, anemia, and ischemic heart disease. In Kaplan-Meyer analysis, patients with higher MELD-XI (≥11) scores showed a worse prognosis than did those with lower (<11) scores (log-rank p≤0.001). Multivariate Cox proportional hazards testing revealed MELD-XI as an independent predictor of CV events (HR: 1.033, 95% CI: 1.006-1.061, p = 0.015) after adjusting for age, gender, body mass index, NYHA III/IV, prior HF hospitalization, systolic blood pressure, ischemic etiology, ventricular tachycardia, anemia, BNP, and left ventricular ejection fraction.

Conclusions: Cardio-renal and cardio-hepatic interactions predicted CV events in aged HF patients.

Publication types

  • Multicenter Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Anemia / epidemiology
  • Anemia / physiopathology
  • Angiotensin-Converting Enzyme Inhibitors / therapeutic use
  • Comorbidity
  • Electrocardiography
  • Female
  • Heart Failure / mortality*
  • Heart Failure / physiopathology*
  • Humans
  • Hypertension / drug therapy
  • Hypertension / epidemiology
  • Kaplan-Meier Estimate
  • Liver / physiopathology*
  • Male
  • Natriuretic Peptide, Brain / blood
  • Prognosis
  • Retrospective Studies
  • Ventricular Function, Left


  • Angiotensin-Converting Enzyme Inhibitors
  • Natriuretic Peptide, Brain

Grant support

The authors received no specific funding for this work.