Endovasküler Girişim Uygulanan Periferik Arter Hastalarında MELD-Albumin Skorunun Öngörücü Değeri: İki Yıllık Takip

Yıl 2025, Cilt: 22 Sayı: 3, 418 - 425

Seçkin Dereli , Onur Osman Şeker Osman Eren Kır

https://doi.org/10.35440/hutfd.1519389

Öz

Amaç: Periferik arter hastalığı (PAH), sistemik aterosklerozun bir yansıması olup, hastaları hem majör advers kardiyak olaylar (MACE) hem de majör advers ekstremite olayları (MALE) açısından yüksek risk altında bırakmaktadır. Bu çalışmanın temel amacı, endovasküler girişim uygulanan bu yüksek riskli hasta popülasyonunda, rutin kan tetkiklerinden kolayca hesaplanabilen MELD-XI ve MELD-Albumin skorlarının, 24 aylık takipte MACE ve MALE'i öngörmedeki prognostik gücünü karşılaştırmalı olarak değerlendirmek ve bu skorların klinik karar mekanizmalarındaki potansiyel yerini aydınlatmaktır.
Materyal ve metod: Çalışmamız, 2018 ile 2022 yılları arasında kliniğimizde alt ekstremite PAH tanısıyla endovasküler girişim uygulanmış 427 hastanın verilerinin retrospektif olarak analiz edildiği bir kohort çalışmasıdır. Hastalar, MELD-Albumin skorlarına göre beş eşit gruba (quintile) ayrılmıştır. Birincil sonlanım noktaları, 24 aylık takip süresince gelişen MACE (kardiyovasküler ölüm, ölümcül olmayan miyokart enfarktüsü, ölümcül olmayan inme) ve MALE (majör ampütasyon, tekrar endovasküler veya cerrahi revaskülarizasyon) olarak tanımlanmıştır. Skorların ayırt edicilik kapasiteleri Alıcı İşletim Karakteristiği (ROC) eğrisi analizi ile, bağımsız öngördürücü rolleri ise çok değişkenli Cox regresyon analizi ile incelenmiştir.
Bulgular: Çalışma popülasyonumuzda, MELD-Albumin skoru arttıkça hastaların demografik ve klinik risk profillerinin ağırlaştığı gözlenmiştir. Yüksek MELD-Albumin skoruna sahip gruplarda ileri yaş, diyabet, hipertansiyon, kronik böbrek hastalığı ve daha karmaşık lezyon morfolojisi gibi faktörler istatistiksel olarak anlamlı düzeyde daha yaygındı (tümü için p<0.001). Klinik takip neticesinde, en yüksek MELD-Albumin skoruna sahip beşinci gruptaki (Q5) hastaların, en düşük skorlu gruba (Q1) kıyasla hem MACE hem de MALE oranlarının dramatik şekilde arttığı saptanmıştır (kardiyovasküler ölüm için %26.8'e karşılık %2.7; majör amputasyon için %18.6'ya karşılık %6.0; p<0.001). Prognostik performans analizinde, MELD-Albumin skorunun MACE'i öngörmede (Eğri Altında Kalan Alan [AUC]: 0.872; %95 GA: 0.785-0.892) ve MALE'i öngörmede (AUC: 0.803; %95 GA: 0.739-0.869) MELD-XI skoruna (sırasıyla AUC: 0.723 ve 0.583) kıyasla istatistiksel olarak anlamlı derecede üstün bir öngörü gücüne sahip olduğu kanıtlanmıştır. Cox regresyon analizi, MELD-Albumin skorunun yaş, diyabet ve diğer bilinen risk faktörlerinden bağımsız olarak hem MACE hem de MALE için güçlü bir bağımsız belirteç olduğunu ortaya koymuştur (p<0.001).
Sonuç: MELD-Albumin skoru, karaciğer-böbrek aksının fonksiyonel durumunu ve hastanın nutrisyonel/enflamatuar statüsünü yansıtan biyobe-lirteçleri bir araya getirerek, endovasküler tedavi uygulanan PAH hastalarında gelecekteki kardiyovasküler ve ekstremiteye bağlı olumsuz olayları öngörmede basit, maliyet-etkin ve güçlü bir prognostik araçtır. Bulgularımız, bu skorun MELD-XI'e kıyasla daha üstün bir performansa sahip olduğunu ve klinisyenlerin risk sınıflandırması yaparak tedavi stratejilerini bireyselleştirmelerine yardımcı olabileceğini güçlü bir şekilde desteklemektedir.

Anahtar Kelimeler: MELD-Albumin Skoru, Periferik Arter Hastalığı, Endovasküler Girişim, Majör Advers Kardiyak Olaylar, Majör Advers Ekstremite Olayları, Prognoz

Anahtar Kelimeler

MELD-Albumin , Periferik Arter Hastalığı , MACE , MALE

Etik Beyan

Çalışma, Helsinki Bildirgesi'ne uygun olarak yürütülmüş olup, Ordu Üniversitesi Klinik Araştırmalar Etik Kurulu'nun 05/04/2024 tarihli toplantısında 51 karar numarası ile onaylanmıştır. Hastalardan bilgilendirilmiş onam formu alınmıştır.

Predictive Value of MELD-Albumin Score in Patients with Peripheral Artery Disease Undergoing Endovascular Intervention: Two-Years Follow-Up

Öz

Background: Peripheral artery disease (PAD) is a manifestation of systemic atherosclerosis and places patients at high risk for both major adverse cardiac events (MACE) and major adverse limb events (MALE). The primary objective of this study is to compare the prognostic value of MELD-XI and MELD-Albumin scores, which can be easily calculated from routine blood tests, in predicting MACE and MALE at 24 months of follow-up in this high-risk patient population undergoing endovascular intervention, and to elucidate the potential role of these scores in clinical decision-making mechanisms.
Materials and Methods: Our study is a retrospective cohort analysis of data from 427 patients who underwent endovascular intervention for lower extremity PAH at our clinic between 2018 and 2022. Patients were divided into five equal groups (quintiles) based on their MELD-Albumin scores. Primary endpoints were defined as MACE (cardiovascular death, non-fatal myocardial infarction, non-fatal stroke) and MALE (major amputation, repeat endovascular or surgical revascularization) occurring during a 24-month follow-up period. The discriminatory capaci-ty of the scores was analyzed using Receiver Operating Characteristic (ROC) curve analysis, while their independent predictive roles were examined using multivariate Cox regression analysis.
Results: In our study population, an increase in the MELD-Albumin score was associated with worsening demographic and clinical risk profiles. In groups with high MELD-Albumin scores, factors such as advanced age, diabetes, hypertension, chronic kidney disease, and more complex lesion morphology were statistically significantly more prevalent (p<0.001 for all). Following clinical follow-up, patients in the fifth group (Q5) with the highest MELD-Albumin scores had dramatically increased rates of both MACE and MALE compared to the lowest-scoring group (Q1) (26.8% vs. 2.7% for cardiovascular death; 18.6% vs. 6.0% for major amputation; p<0.001). In prognostic performance analysis, the MELD-Albumin score demonstrated statistically significantly superior predictive power for predicting MACE (Area Under the Curve [AUC]: 0.872; 95% CI: 0.785–0.892) and MALE (AUC: 0.803; 95% CI: 0.739–0.869) compared to the MELD-XI score (with AUC: 0.723 and 0.583), respectively. Cox regression analysis demonstrated that the MELD-Albumin score is a strong independent predictor of both MACE and MALE, independent of age, diabetes, and other known risk factors (p<0.001).
Conclusions: The MELD-Albumin score, by combining biomarkers reflecting the functional status of the liver-kidney axis and the patient's nutritional/inflammatory status, serves as a simple, cost-effective, and robust prognostic tool for predicting future cardiovascular and limb-related adverse events in PAH patients undergoing endovascular therapy. Our findings strongly support that this score outperforms MELD-XI and may assist clinicians in risk stratification and individualization of treatment strategies.

Keywords: MELD-Albumin Score, Peripheral Arterial Disease, Endovascular Intervention, Major Adverse Cardiac Events, Major Adverse Limb Events, Prognosis

Anahtar Kelimeler

: MELD-Albumin , Peripheral Artery Disease , MACE , MALE

Kaynakça

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