Table 1.
Baseline Characteristics of the Study Population According to Hepatorenal Function (MELD‐XI score) and Nutritional Status (CONUT score)
| Characteristics | Overall (n=909) |
Normal (Normal hepatorenal function and well‐nourished; n=316) |
Mild (Hepatorenal dysfunction or malnutrition; n=416) |
Severe (Hepatorenal dysfunction and malnutrition; n=177) |
P value |
|---|---|---|---|---|---|
| Demographic and anthropometric characteristics | |||||
| Age, y | 63 (57–69) | 60 (54–65)†,‡ | 64 (57–71)* | 65 (60–70)* | <0.001 |
| Male | 431 (47.4) | 132 (41.8)‡ | 192 (46.2)‡ | 107 (60.5)*,† | <0.001 |
| Height, cm | 159 (153–166) | 159 (154–165) | 159 (153–166) | 160 (153–166) | 0.969 |
| Weight, kg | 58 (50–67) | 61 (52–70)†,‡ | 57 (50–66)* | 57 (49–67)* | 0.002 |
| Body mass index, kg/m2 | 23.0 (20.6–25.6) | 23.8 (21.3–25.9)†,‡ | 22.7 (20.2–25.5)* | 22.6 (19.7–25.4)* | 0.002 |
| NYHA Class III/IV | 69 (7.6) | 18 (5.7)‡ | 24 (5.8)‡ | 27 (15.3)*,† | <0.001 |
| Cardiovascular risk factors and cardiovascular disease | |||||
| Hypertension | 290 (31.9) | 78 (24.7)†,‡ | 146 (35.1)* | 66 (37.3)* | 0.003 |
| Diabetes | 165 (18.2) | 27 (8.5)†,‡ | 83 (20.0)*,‡ | 55 (31.1)*,† | <0.001 |
| Dyslipidemia | 231 (25.4) | 64 (20.3)† | 120 (28.8)* | 47 (26.6) | 0.028 |
| Smoking | 178 (19.6) | 65 (20.6) | 71 (17.1) | 42 (23.7) | 0.150 |
| Prior myocardial infarction | 37 (4.1) | 6 (1.9) | 21 (5.0) | 10 (5.6) | 0.507 |
| Prior stroke | 82 (9.1) | 16 (5.1)†,‡ | 42 (10.2)* | 4 (13.7)* | 0.004 |
| Heart failure | 393 (43.2) | 114 (36.1)‡ | 171 (41.1)‡ | 108 (61.0)*,† | <0.001 |
| Atrial fibrillation | 487 (53.6) | 134 (42.4)†,‡ | 231 (55.5)*,‡ | 122 (68.9)*,† | <0.001 |
| Comorbidities | |||||
| Chronic obstructive pulmonary disease | 52 (5.7) | 13 (4.1) | 28 (6.7) | 11 (6.2) | 0.304 |
| Cancer | 52 (5.7) | 19 (6.0) | 26 (6.3) | 7 (4.0) | 0.525 |
| Laboratory examination | |||||
| Hemoglobin, g/dL | 12.9 (11.6–14.0) | 13.3 (12.5–14.4)†,‡ | 12.8 (11.6–14.0)*,‡ | 11.3 (9.9–12.9)*,† | <0.001 |
| White blood cell count, ×109/L | 5.9 (4.9–7.0) | 6.0 (5.2–6.9) | 5.9 (4.6–7.3) | 5.7 (4.7–6.8) | 0.287 |
| Platelet count, ×109/L | 189 (157–227) | 200 (174–234)†,‡ | 185 (153–222)*,‡ | 170 (128–213)*,† | <0.001 |
| Creatinine, mg/dL | 0.92 (0.78–1.14) | 0.86 (0.76–1.00)†,‡ | 0.89 (0.77–1.06)*,‡ | 1.38 (1.12–1.61)*,† | <0.001 |
| eGFR, mL/min per 1.73 m2 | 75.9 (60.9–90.1) | 83.1 (72.8–95.1)†,‡ | 78.1 (65.7–90.7)*,‡ | 51.3 (36.9–61.5)*,† | <0.001 |
| AST, U/L | 27 (22–35) | 26 (22–32)†,‡ | 27 (22–35)*,‡ | 30 (25–41)*,† | <0.001 |
| ALT, U/L | 21 (16–29) | 22 (17–29)‡ | 21 (16–29) | 20 (15–25)* | 0.046 |
| ALP, U/L | 71 (58–90) | 66 (55–83)†,‡ | 71 (58–87)*,‡ | 83 (64–124)*,† | <0.001 |
| Total bilirubin, mg/dL | 0.53 (0.75–1.14) | 0.63 (0.47–0.84)†,‡ | 0.77 (0.56–1.08)*,‡ | 1.56 (0.80–2.20)*,† | <0.001 |
| Total cholesterol, mg/dL | 159 (134–188) | 189 (167–211)†,‡ | 147 (128–169)*,‡ | 135 (116–154)*,† | <0.001 |
| Albumin, g/dL | 4.2 (4.0–4.4) | 4.3 (4.1–4.5)†,‡ | 4.2 (4.0–4.4)*,‡ | 4.0 (3.7–4.3)*,† | <0.001 |
| Valvular heart disease and echocardiographic variables | |||||
| MS ≥ moderate | 229 (25.2) | 81 (29.7) | 109 (30.6) | 39 (26.5) | 0.657 |
| MR ≥ moderate | 411 (45.2) | 149 (47.8) | 170 (41.4)‡ | 92 (52.6)† | 0.031 |
| AS ≥ moderate | 322 (35.4) | 108 (38.3) | 159 (41.7) | 55 (34.6) | 0.281 |
| AR ≥ moderate | 231 (25.4) | 90 (30.3) | 99 (24.5) | 42 (24.1) | 0.171 |
| TR ≥ moderate | 365 (40.2) | 78 (24.7)†,‡ | 177 (42.5)*,‡ | 110 (62.5)*,† | <0.001 |
| Chronic rheumatic heart disease | 259 (28.5) | 84 (26.6) | 123 (29.6) | 52 (29.4) | 0.647 |
| LV mass, g | 224 (176–294) | 221 (175–294)†,‡ | 219 (169–282)*,‡ | 249 (198–320)*,† | <0.001 |
| LVEF, % | 60 (55–60) | 60 (55–60)‡ | 60 (55–60)‡ | 55 (50–60)*,† | <0.001 |
| Preserved, ≥50% | 763 (84.3) | 278 (88.3)‡ | 348 (83.9) | 137 (78.3)* | 0.014 |
| Midrange, 40%–49% | 57 (6.3) | 18 (5.7) | 29 (7.0) | 10 (5.7) | 0.734 |
| Reduced, <40% | 55 (6.1) | 11 (3.5)‡ | 24 (5.8) | 20 (11.4)* | 0.002 |
| PASP, mm Hg | 40 (35–50) | 40 (30–45) †,‡ | 40 (35–50)*,‡ | 45 (40–55) *,† | <0.001 |
| Medications | |||||
| ACEI | 286 (31.5) | 82 (25.9)‡ | 137 (32.9) | 67 (37.9)* | 0.016 |
| ARB | 142 (15.6) | 45 (14.2) | 72 (17.3) | 25 (14.1) | 0.437 |
| Aldactone | 117 (12.9) | 20 (6.3)†,‡ | 51 (12.3)*,‡ | 46 (26.0)*,† | <0.001 |
| β‐Blockers | 374 (41.1) | 116 (36.7)‡ | 171 (41.1) | 87 (49.2)* | 0.027 |
| Calcium channel blockers | 185 (20.4) | 59 (18.7) | 93 (22.4) | 33 (18.6) | 0.387 |
| Digoxin | 269 (29.6) | 80 (25.3)‡ | 113 (27.2)‡ | 76 (42.9)*,† | <0.001 |
| Statin | 373 (41.0) | 82 (25.9)†,‡ | 213 (51.2)* | 78 (44.1)* | <0.001 |
| Warfarin | 417 (45.9) | 115 (36.4)†,‡ | 198 (47.6)*,‡ | 104 (58.8)*,† | <0.001 |
| Cardiac surgery risk‐stratification models | |||||
| EuroScore II | 2.42 (1.33–4.50) | 1.73 (1.01–2.85)†,‡ | 2.49 (1.53–4.72)*,‡ | 4.25 (2.77–8.82)*,† | <0.001 |
| STS Score | 1.49 (0.87–2.76) | 1.12 (0.63–1.80)†,‡ | 1.63 (1.02–2.75)*,‡ | 3.02 (1.39–5.40)*,† | <0.001 |
| Valvular surgery details | |||||
| Aortic valve replacement | 460 (50.7) | 164 (51.9) | 214 (51.4) | 82 (46.6) | 0.482 |
| Mitral valve procedure | 554 (61.0) | 192 (61.0) | 245 (58.9) | 117 (66.1) | 0.258 |
| Mitral valve replacement | 295 (32.5) | 97 (30.7) | 138 (33.2) | 60 (33.9) | 0.701 |
| Mitral valve repair | 259 (28.6) | 95 (30.2) | 107 (25.7) | 57 (32.6) | 0.181 |
| Tricuspid annuloplasty | 319 (35.2) | 77 (24.4)†,‡ | 151 (36.3)*,‡ | 91 (52.0)*,† | <0.001 |
| Concomitant CABG | 107 (11.8) | 18 (5.7)†,‡ | 59 (14.2)* | 30 (17.1)* | <0.001 |
| Emergency operation | 20 (2.2) | 3 (0.9) | 10 (2.4) | 7 (4.0) | 0.086 |
| Inotropic support | 198 (21.8) | 55 (17.4) | 100 (24.0) | 43 (24.3) | 0.065 |
| Operative complications | |||||
| Major bleeding events | 11 (1.2) | 2 (0.6) | 6 (1.4) | 3 (1.7) | 0.493 |
| Stroke | 4 (0.4) | 3 (0.9) | 0 (0.0) | 1 (0.6) | 0.152 |
Values are expressed as median (interquartile range) or number (percentage). P value by Kruskal–Wallis H test for non‐normally distributed continuous variables. P value by χ2 test for categorical variables (Bonferroni correction: *P<0.05 vs normal [normal hepatorenal function and well‐nourished]; † P<0.05 vs mild [hepatorenal dysfunction or malnutrition]; ‡ P<0.05 vs severe [hepatorenal dysfunction and malnutrition]). ACEI indicates angiotensin‐converting enzyme inhibitors; ALP, alkaline phosphatase; ALT, alanine aminotransaminase; AR, aortic regurgitation; ARB, angiotensin II receptor blockers; AS, aortic stenosis; AST, aspartate aminotransferase; CABG, coronary artery bypass grafting; CONUT, controlling nutritional status; eGFR, estimated glomerular filtration rate; EuroSCORE II, European System for Cardiac Operative Risk Evaluation II; LV, left ventricle; LVEF, left ventricular ejection fraction; MELD‐XI, modified model for end‐stage liver disease excluding international normalized ratio; PASP, pulmonary artery systolic pressure; MR, mitral regurgitation; MS, mitral stenosis; NYHA, New York Heart Association; STS score, Society of Thoracic Surgeons Predicted Risk of Mortality Score; and TR, tricuspid regurgitation.