Hepatorenal dysfunction identifies high‐risk patients with acute heart failure: insights from the RELAX‐AHF trial

AIMS: Episodes of acute heart failure (AHF) may lead to end‐organ dysfunction. In this post hoc analysis of the Relaxin in Acute Heart Failure trial, we used the MELD‐XI (Model of End‐Stage Liver Dysfunction) score to examine hepatorenal dysfunction in patients with AHF. METHODS AND RESULTS: On admission, the MELD‐XI score was elevated (abnormal) in 918 (82%) patients, with 638 (57%) having isolated renal dysfunction (creatinine > 1 mg/dL), 73 (6.5%) isolated liver dysfunction (bilirubin > 1 mg/dL), and 207 (18.5%) coexisting dysfunction of the kidneys and the liver (both creatinine and bilirubin > 1 mg/dL). The percentage of patients with elevated MELD‐XI score remained constant through a 60 day follow‐up, as we observed a gradual decrease of liver dysfunction prevalence, counterbalanced by an increase in renal dysfunction. Serelaxin treatment was associated with a lower MELD‐XI score on Day 2 and Day 5 (both P < 0.05), but this difference vs. placebo disappeared during longer follow‐up. In the multivariable model, an elevated MELD‐XI score on admission was associated with higher 180 day mortality: hazard ratios (95% confidence interval) for cardiovascular death were 3.10 (1.22–7.87), and for all‐cause death 2.47 (1.19–5.15); both P < 0.05. The addition of the MELD‐XI score to a prespecified prognostic model increased the discrimination of the model for all‐cause death, but the increment in the C‐index was only modest: 0.013 (P = 0.02). CONCLUSIONS: In patients with AHF, hepatorenal dysfunction is prevalent and related to poor outcome. The MELD‐XI score is a useful prognosticator in AHF.