Preoperative Levels of Bilirubin or Creatinine Adjusted by Age Can Predict Their Reversibility After Implantation of Left Ventricular Assist Device
2013 (English)In: Circulation Journal, ISSN 1346-9843, E-ISSN 1347-4820, Vol. 77, no 1, 96-104 p.Article in journal (Refereed) Published
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.
Place, publisher, year, edition, pages
Japanese Circulation Society , 2013. Vol. 77, no 1, 96-104 p.
Heart failure; Liver; Renal failure; Transplantation; Ventricular assist device
IdentifiersURN: urn:nbn:se:liu:diva-111190DOI: 10.1253/circj.CJ-12-0686ISI: 000313302600019OAI: oai:DiVA.org:liu-111190DiVA: diva2:754502
Funding Agencies|FUGAKU trust for medicinal research; Japan Society for the Promotion of Science ; Japan Society for the Promotion of Science (JSPS) through its Funding Program for World-Leading Innovative RandD on Science and Technology (FIRST Program)2014-10-102014-10-102014-10-20Bibliographically approved