One-year survival of ambulatory patients with end-stage heart failure: the analysis of prognostic factors

Introduction An increasing number of ambulatory patients are placed on orthotopic heart transplantation (OHT) waiting lists, which results in an extended waiting time and a higher mortality rate. Objectives The aim of this study was to identify the factors associated with reduced survival during a 1-year follow-up in patients with end-stage heart failure listed for an OHT. Patients and methods We retrospectively analyzed the data of 221 adult patients, who were accepted for OHT in our institution over a 2-year period between 2013 and 2014. Results The mean (SD) age of the patients was 54.7 (9.6) years, and 90.1% of them were male. The mortality rate during the follow-up period was 43.3%. The modified Model for End-Stage Liver Disease (modMELD) score (odds ratio [ OR], 1.70; P < 0.001), as well as the plasma levels of high-sensitivity C-reactive protein (hs-CRP; OR, 1.10; P < 0.01), sodium (OR, 0.74; P < 0.001), and uric acid (UA; OR, 1.003; P < 0.05) were independent factors affecting death. The receiver-operating characteristic (ROC) analysis indicated that a modMELD cut-off of 10 (area under the ROC curve [AUC], 0.868; P < 0.001), hs-CRP cut-off of 5.6 mg/l (AUC, 0.674; P < 0.001), plasma sodium level cut-off of 135 mmol/l (AUC, 0.778; P < 0.001), and a plasma UA cut-off of 488 mu mol/l (AUC, 0.634; P < 0.001) were the most accurate factors affecting death. Conclusions In conclusion, although limited to a single center, our study demonstrated that an elevated modMELD score, incorporating a combination of renal and hepatic laboratory parameters, as well as plasma sodium, UA, and hs-CRP levels at the time of listing are associated with reduced survival in ambulatory patients with end-stage heart failure, accepted for OHT.