Table 2.
Cox Proportional Hazards Analyses of Baseline Hepatorenal function (MELD‐XI) and Nutritional Status (CONUT) for Predicting All‐Cause Mortality
| Overall population | ||||||
|---|---|---|---|---|---|---|
| Univariate analysis |
Multivariate analysis (EuroSCORE II model) |
Multivariate analysis (STS score model) |
||||
| HR (95% CI) | P value | HR (95% CI) | P value | HR (95% CI) | P value | |
| Demographic and anthropometric characteristics | ||||||
| Age, y | 1.06 (1.04–1.08) | <0.001 | ||||
| Male | 1.09 (0.74–1.61) | 0.667 | ||||
| Body mass index, kg/m2 | 1.02 (0.97–1.08) | 0.398 | ||||
| NYHA Class III/IV | 1.73 (0.96–3.09) | 0.067 | ||||
| Cardiovascular risk factors and cardiovascular disease | ||||||
| Hypertension | 2.01 (1.36–2.97) | <0.001 | 1.82 (1.13–2.93) | 0.014 | ||
| Diabetes | 3.16 (2.12–4.70) | <0.001 | ||||
| Smoking | 0.86 (0.52–1.44) | 0.575 | ||||
| Dyslipidemia | 2.05 (1.38–3.06) | <0.001 | 1.62 (1.02–2.57) | 0.042 | 1.79 (1.15–2.78) | 0.010 |
| Prior myocardial infarction | 2.03 (0.98–4.17) | 0.055 | ||||
| Prior stroke | 2.32 (1.39–3.86) | 0.001 | 1.61 (0.93–2.78) | 0.088 | 1.70 (0.95–3.06) | 0.074 |
| Atrial fibrillation | 1.33 (0.89–1.98) | 0.159 | ||||
| Heart failure | 1.47 (1.00–2.18) | 0.052 | ||||
| Laboratory examination | ||||||
| Hemoglobin, g/dL | 0.66 (0.60–0.73) | <0.001 | ||||
| eGFR, mL/min per 1.73 m2 | 0.97 (0.96–0.98) | <0.001 | ||||
| Total bilirubin, mg/dL | 1.42 (1.15–1.74) | <0.001 | ||||
| Total cholesterol, mg/dL | 0.984 (0.978–0.990) | <0.001 | ||||
| Albumin, mg/dL | 0.38 (0.24–0.60) | <0.001 | ||||
| Valvular heart disease and echocardiographic variables | ||||||
| MS ≥ moderate | 0.86 (0.52–1.43) | 0.566 | ||||
| MR ≥ moderate | 0.46 (0.30–0.71) | <0.001 | 0.50 (0.29–0.88) | 0.015 | ||
| AS ≥ moderate | 1.42 (0.94–2.15) | 0.1 | ||||
| AR ≥ moderate | 0.91 (0.58–1.44) | 0.701 | ||||
| TR ≥ moderate | 2.28 (1.53–3.39) | <0.001 | 2.38 (1.40–4.04) | 0.002 | ||
| Chronic Rheumatic Heart Disease | 1.35 (0.89–2.04) | 0.157 | ||||
| LV mass, g | 1.001 (0.999–1.003) | 0.221 | ||||
| LVEF, % | 0.98 (0.96–1.00) | 0.019 | ||||
| PASP, mm Hg | 1.01 (0.99–1.02) | 0.370 | ||||
| Medications | ||||||
| ACEI | 1.48 (0.99–2.20) | 0.056 | ||||
| ARB | 0.96 (0.55–1.66) | 0.876 | ||||
| β‐Blockers | 0.79 (0.53–1.19) | 0.259 | ||||
| Calcium channel blockers | 1.04 (0.64–1.68) | 0.876 | ||||
| Digoxin | 1.44 (0.97–2.16) | 0.074 | ||||
| Statin | 1.44 (0.97–2.13) | 0.067 | ||||
| Warfarin | 1.49 (1.00–2.20) | 0.048 | 1.15 (0.68–1.95) | 0.600 | 1.47 (0.91–2.36) | 0.113 |
| Valvular surgery details | ||||||
| Aortic valve replacement | 1.63 (1.09–2.44) | 0.017 | 1.30 (0.81–2.10) | 0.281 | 1.36 (0.77–2.41) | 0.288 |
| Mitral valve procedure | 0.56 (0.38–0.83) | 0.004 | 0.67 (0.39–1.15) | 0.149 | 0.47 (0.27–0.84) | 0.010 |
| Mitral valve replacement | 0.75 (0.48–1.17) | 0.198 | ||||
| Mitral valve repair | 0.64 (0.39–1.03) | 0.065 | ||||
| Tricuspid annuloplasty | 1.36 (0.92–2.02) | 0.126 | ||||
| Concomitant CABG | 1.28 (0.74–2.22) | 0.376 | ||||
| Cardiac surgery risk‐stratification models | ||||||
| EuroScore II | 1.06 (1.05–1.08) | <0.001 | 1.03 (1.01–1.06) | 0.006 | ||
| STS Score | 1.28 (1.20–1.36) | <0.001 | 1.16 (1.07–1.25) | <0.001 | ||
| Combined evaluation of hepatorenal function and nutritional status | ||||||
|
Normal (Normal hepatorenal function and well–nourished) |
1.00 | 1.00 | 1.00 | |||
|
Mild (Hepatorenal dysfunction or malnutrition) |
4.28 (2.01–9.11) | <0.001 | 3.17 (1.40–7.17) | 0.006 | 2.93 (1.35–6.38) | 0.007 |
|
Severe (Hepatorenal dysfunction and malnutrition) |
13.86 (6.58–29.23) | <0.001 | 9.30 (4.09–21.16) | <0.001 | 8.07 (3.63–17.95) | <0.001 |
ACEI indicates angiotensin‐converting enzyme inhibitors; AR, aortic regurgitation; ARB, angiotensin II receptor blockers; AS, aortic stenosis; CABG, coronary artery bypass grafting; CONUT, controlling nutritional status; eGFR, estimated glomerular filtration rate; EuroSCORE II, European System for Cardiac Operative Risk Evaluation II; HR, hazard ratio; LV, left ventricle; LVEF, left ventricular ejection fraction; MELD‐XI, modified model for end‐stage liver disease excluding international normalized ratio; MR, mitral regurgitation; MS, mitral stenosis; NYHA, New York Heart Association; PASP, pulmonary artery systolic pressure; STS score, Society of Thoracic Surgeons Predicted Risk of Mortality Score; and TR, tricuspid regurgitation.