Evidence map›Paper›PMID 31568696›Full record

Trial reportESC heart failure2019

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

Jan Biegus, Biniyam Demissei, Douwe Postmus, Gad Cotter, Beth A Davison, G Michael Felker, Gerasimos Filippatos, Claudio Gimpelewicz, Barry Greenberg, Marco Metra and 4 more

Open access · goldAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in ESC heart failure, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 25 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
25citing papers in PubMed, 2 pooled it
3.8field-weighted citation impact, top 7% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

25 citing papers in PubMed, 2 syntheses or guidelines pooled it, 33 citations in OpenAlex.

  1. Pooled it
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  7. Harnessing the lymphatic system.Heart failure reviews · 2025
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

14 authors at 9 institutions in 9 countries.

Jan BiegusDepartment of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland.ORCID 0000-0001-9977-7722
Biniyam DemisseiDepartment of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Douwe PostmusDepartment of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Gad CotterMomentum Research, Inc., Durham, NC, USA.
Beth A DavisonMomentum Research, Inc., Durham, NC, USA.
G Michael FelkerDuke Clinical Research Institute, Durham, NC, USA.
Gerasimos FilippatosSchool of Medicine, University of Cyprus, Nicosia, Cyprus.
Claudio GimpelewiczNovartis Pharma AG, Basel, Switzerland.
Barry GreenbergUniversity of California at San Diego, San Diego, CA, USA.
Marco MetraInstitute of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy.
Thomas SeverinNovartis Pharmaceuticals Corporation, New Hanover, NJ, USA.
John R TeerlinkSection of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California San Francisco, San Francisco, CA, USA.
Adriaan A VoorsDepartment of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Piotr PonikowskiDepartment of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland.
University Medical Center Groningen · NLMilitary Hospital · PKMomentum Research · USNovartis (Switzerland) · CHClinical Research Institute · USSan Francisco VA Medical Center · USSurgical Specialties (Canada) · CAUniversity of California San Diego · USUniversity of Nicosia · CY

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

aimsEpisodes 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

resultsOn 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).

conclusionsIn patients with AHF, hepatorenal dysfunction is prevalent and related to poor outcome. The MELD-XI score is a useful prognosticator in AHF.

Indexed as

Heart FailureKidney DiseasesLiver DiseasesAcute DiseaseAgedAged, 80 and overBilirubinCreatinineFemaleHumansMaleMiddle AgedPrognosisSeverity of Illness IndexBilirubinCreatinineAcute heart failureKidney dysfunctionLiver dysfunctionMELD-XI scorePrognosis

Identifiers

PMID31568696
PMCPMC6989278
OpenAlexW2979159761

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.