Preoperative Levels of Bilirubin or Creatinine Adjusted by Age Can Predict Their Reversibility After Implantation of Left Ventricular Assist Device

• Background: It is often difficult to predict reversibility of liver or renal function after left ventricular assist device (LVAD) implantation in patients with stage D heart failure. Methods and Results: Data were obtained for 69 patients who had received a LVAD (18 continuous-flow, 51 pulsatile). Persistent hepatic or renal dysfunction was defined as levels of total bilirubin (TB) or creatinine (Cre) greater than1.5 mg/dl at 6 months after LVAD implantation. TB score or Cre score was calculated: 0.15 x age+ 1.1x (preoperative TB) or 0.2 x age + 3.6 x (preoperative Cre), in which coefficients were determined on the basis of odds ratios for persistent hepatic or renal dysfunction, respectively. Receiver-operating characteristics analyses showed good predictabilities for persistent end-organ dysfunction (area under curve: 0.794 for TB score and 0.839 for Cre score). High-risk strata of TB score (greater than11.0 points) or Cre score (greater than14.1 points) were associated with persistently higher levels of TB or Cre (TB, 1.32 +/- 0.51; Cre, 1.23 +/- 0.41 mg/dl; both Pless than0.001 vs. low-risk strata). Conclusions: Reversibility of end-organ function with LVAD implantation can be well predicted by our new risk scoring system that consists of the preoperative TB or Cre level adjusted by the patients age. The scoring system would be beneficial, especially in considering the indication of a bridge to candidacy.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Hälsovetenskap (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Health Sciences (hsv//eng)

Nyckelord

Heart failure; Liver; Renal failure; Transplantation; Ventricular assist device

Publikations- och innehållstyp

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