MELD-Ⅺ Score Is Associated With Short-Term Adverse Events In Patients With HFpEF:A Study Based On Database Technology

Objective Accumulating evidence suggests that MELD-Ⅺ score holds the ability to predict the prognosis of congestive heart failure.However,most of the evidence is based on end-stage heart failure population and patients undergoing cardiac transplantation,thus we aim to explore the association between MELD-Ⅺ score and the prognosis in heart failure with preserved ejection fraction(HFpEF).Methods A total of 30081 patients hospitalized for HFpEF in a specific Hospital between January 1,2014 and July 17,2020 with available measures of creatinine and liver function were enrolled,whose clinical data were collected via information technological methods and imported into SQLite database.Thus a research-oriented heart failure database was constructed to sort out raw data,calculate secondary variables and help investigators to determine endpoints according to research requirements.The primary endpoints were 60-day in-hospital all-cause mortality.Secondary endpoints were 60-day in-hospital cardiovascular mortality and 30-days re-hospitalization for heart failure.Results A research-oriented database which contained 273 key variables and 28 endpoints was constructed to empower all subsquent analysis.A total of 222 patients died within 60 days after admission,among which 75 deaths were considered cardiogenic.And 73 patients were readmitted for heart failure within 30-days after discharge.Generally,patients with elevated MELD-Ⅺ score tended to have more comorbidities,higher NYHA class and higher inflammatory biomarkers levels.MELD-Ⅺ score was positively correlated with NT-pro BNP,E/e’ and left atrial diameter.Meanwhile MELD-Ⅺ score was negativly correlated with LVEF.After adjusting for conventional risk factors,MELD-Ⅺ score was an independent risk factor for 60-day in-hospital all-cause mortality(hazard ratio(HR)=1.052,95%confidential interval(CI)1.022-1.083,P=0.001),60-day in-hospital cardiovascular mortality(HR=1.064,95% CI 1.013-1.118,P=0.014)and 30-day readmission for heart failure(HR=1.061,95% CI 1.015-1.108,P=0.009).These results confirmed that MELD-Ⅺ was a independent predictor of the adverse prognosis in patients with HFpEF.Furthermore,MELD-Ⅺ score added minor increment discriminatory capacity to risk stratification models developed based on the HFpEF cohort in this study,which means MELD-Ⅺ contributed to the risk stratification of HFpEF.These results were also interpreted into a nomogram and a calibration curve.In addition,a large local research-oriented heart failure database was established powered by database technology,which contains 273 key variables and 28 outcomes.We are now beginning a patent application for the database.Despite the basic management,consulting and export function,this database was also created with the ability to sort and screen cases as well as determine endpoints according to research interests with approximate performance of artificial intelligence.Conclusion MELD-Ⅺ score was associated with cardiac function and short-term adverse events in patients hospitalized for HFpEF and also provided increment discriminatory capacity to risk stratification models.