Background/Objectives: Multi-organ failure (MOF) often complicates advanced heart failure (HF), contributing to a poor prognosis. The Model of End-Stage Liver Disease 3.0 (MELD-3.0) scale incorporates liver and kidney function parameters. This study aims to evaluate the prognostic significance of the MELD-3.0 score in patients with advanced HF who have undergone heart transplantation (HTx). Methods: The MELD-3.0 score was computed using the average values of the international normalized ratio and bilirubin, creatinine, sodium, and albumin levels during a hospital stay following HTx. The average MELD-3.0 scores from the period of 1 month preceding HTx and 1 week after HTx were analyzed. The primary endpoint of the study was the 6-month total mortality, and the secondary endpoint was ICU hospitalization time after HTx. Results: The analysis included 106 patients undergoing HTx, with a median age of 53 years (44–63), 81% of whom were male. Within 6 months post-HTx, 17 patients (16%) died; those patients had a higher 1-week post-HTx MELD-3.0 score of 18.3 (14.5–22.7) in comparison to survivors, whose average score was 13.9 (9.5–16.4), p < 0.01. There was no difference in MELD 3.0 score in the pre-HTx period: 16.6 (11.4–17.8) vs. 12.3 (8.6–17.1), p = 0.36. The post-HTx MELD-3.0 score independently predicted death: RR 1.17 (95% CI 1.05–1.30), p < 0.01. A Receiver Operating Characteristic (ROC) determined the cut-off value of the MELD-3.0 score as 17.3 (AUC = 0.83; sensitivity—67%; specificity—86%). Survivors with scores above this value had a longer ICU hospitalization time: 7 (5.0–11.0) vs. 12 (8–20) days (p = 0.01). Conclusions: The post-HTx MELD-3.0 score serves as an independent predictor of an unfavorable prognosis in patients with advanced HF undergoing HTx. The evaluation of MELD-3.0 scores provides additional prognostic information in this population.

Background: Multi-organ failure (MOF) is a common complication of advanced heart failure (HF), significantly influencing patient prognosis. This study aimed to assess and compare the impact of orthotopic heart transplantation (HTx) and left ventricular assist device (LVAD) implantation on the severity of MOF, as measured by the model for end-stage liver disease excluding INR (MELD-XI) score. Methods: Data from 1 month before to 1 year after HTx or LVAD implantation were analysed. The MELD-XI score was calculated using average bilirubin and creatinine values. Comparative assessments of MELD-XI scores were performed within the HTx and LVAD groups at various time points pre- and post-procedure. Results: The analysis included 107 HTx patients and 30 LVAD patients. The median MELD-XI score 1 month pre-procedure was 11.7 (9.4–16.7) in all patients. There were no significant differences in MELD-XI scores between the groups at 3-, 6-, and 12-month follow-ups. However, a significant difference was observed 1 month post-procedure [HTx: 14.8 (9.4–17.7) vs. LVAD: 11.2 (7.3–14.9), p = 0.02]. In the LVAD group, a significant decrease in MELD-XI score was noted for 3 months post-procedure compared to 1 month pre-procedure (p < 0.001), whereas at 6- and 12-month follow-ups the score did not differ from pre-procedural scores. In the HTx group, significant decreases in MELD-XI scores were observed from 3 months, 6 months, and 1 year post-procedure compared to 1 month pre-procedure (p < 0.002). Conclusions: The MELD-XI scale reveals different MOF trajectories between HTx and LVAD recipients. Both interventions lead to early improvements in liver and kidney function, with sustained benefits in HTx patients, highlighting the distinct impacts on organ function.

Background/Objectives: Patients with advanced heart failure (HF) often suffer from impaired kidney function. Based on the pathophysiology of types I and II of cardiorenal syndrome, heart transplantation (Htx) may restore renal function. The aim of this study was to identify predictors of improvement in kidney function after HTx. Methods: Htx patients from a tertiary hospital were retrospectively divided into three groups—improvement (n = 24), deterioration (n = 31) and no significant change in eGFR (n = 45)—based on changes in their mean estimated glomerular filtration rate (eGFR) within the first three postoperative months, compared to the last three preoperative months. The threshold for eGFR improvement was defined as a ≥20% increase, while deterioration was defined as a ≥20% decrease. The no significant change group was defined as any change falling between these two values. Results: The median age of analyzed cohort was 54 (45–63) years, and 82% were male. Preoperatively, the improvement group was more frequently treated with inotropes or vasopressors and had significantly higher blood urea and total bilirubin levels before Htx. In the multivariate analysis, total bilirubin before Htx (OR 1.66; 95% CI; 1.24–2.69; p = 0.002) and no need for RRT early after Htx (OR 0.46; 95% CI 0.24–0.88; p = 0.02) were independent predictors of improved kidney function in the first three months after HTx. Conclusions: The improvement in renal function after HTx is uncommon. It could be expected in patients suffering from more severe forms of HF, with impaired kidney and liver function but who did not need RRT after the surgery.

Background: The prevalence of cardiogenic shock (CS) resulting from the progression of heart failure (PHF) is increasing and remains associated with high mortality. This study aimed to compare the clinical characteristics and outcomes of patients who developed CS due to PHF versus those whose CS was caused by other aetiologies (non-PHF). Methods: We retrospectively analysed 280 patients admitted to a Polish tertiary care centre between January 2021 and April 2024. The cohort was divided into two groups: PHF (n = 84, 30%) and non-PHF (n = 196, 70%). Results: Compared to the non-PHF group, PHF patients more frequently had chronic kidney disease (30% vs. 15%, p < 0.01), and significant valvular disease (30% vs. 13%, p < 0.01). PHF patients exhibited significantly lower white blood cell counts (9.4 [6.9–16.4] vs. 13.3 [10.4–17.6], p < 0.01) and troponin T levels (188 [61–1392] vs. 10,921 [809–45,792], p < 0.01). In-hospital mortality was significantly lower among PHF patients (52% vs. 65%, p = 0.04). Although the overall use of mechanical circulatory support (MCS) did not differ between groups, significant differences in the types of MCS applied were observed (p < 0.01). Additionally, PHF patients underwent fewer coronary revascularisation procedures (15% vs. 70%, p < 0.01). Conclusions: Patients with PHF-related CS exhibit distinct clinical profiles and may experience lower in-hospital mortality when appropriately diagnosed and treated with a personalised approach. Further prospective, multicentre studies are warranted to optimize the management of this growing subgroup of CS patients.

Background: Cardiogenic shock (CS) often complicates out-of-hospital cardiac arrest (OHCA), contributing to high mortality despite therapeutic advances. Methods: This study retrospectively analysed patients admitted to a tertiary centre between 2021–2024. The cohort of patients with CS was divided into two groups: OHCA with return of spontaneous circulation and non-OHCA. Results: The study included 280 patients with a median age of 69 (60–76) years, of whom 197 (70%) males. There were 46 (16%) patients in the OHCA group and 234 (84%) in non-OHCA. Acute coronary syndrome (ACS) was a more frequent cause of CS in the OHCA group: 36 (78%) vs. 113 (48%), p < 0.01. The OHCA patients were less likely to have hypertension (41% vs. 63%, p < 0.01), chronic heart failure (CHF) (41% vs. 62%, p < 0.01), and a history of percutaneous coronary intervention (11% vs. 29%, p < 0.01). The OHCA patients exhibited lower C-reactive protein) levels and higher levels of white blood cells. Despite distinct profiles, there was no significant difference in mortality between the study groups. Conclusions: Patients with OHCA and non-OHCA CS exhibited distinct clinical profiles, with ACS as the leading cause of OHCA and chronic conditions were more often diagnosed in non-OHCA cases. Similar mortality rates suggest improved OHCA management, emphasizing the need for extensive data collection to assess shock risk. Keywords: cardiogenic shock out-of-hospital cardiac arrest heart failure acute coronary syndrome mechanical circulatory support hospitalization

Introduction: Heart transplantation (HTx) remains the definitive treatment for selected patients with advanced heart failure. The early post-transplant period is characterized by substantial morbidity and requires intensive surveillance. The aim of this study was to describe the clinical course of the first 100 heart transplant recipients treated at our newly established center, with particular emphasis on in-hospital outcomes and the 12-month follow-up. Methods: We retrospectively analyzed 100 consecutive patients who underwent orthotopic HTx between February 2021 and May 2023 at our center. Demographic, clinical, hemodynamic, laboratory, treatment, and post-transplant follow-up data were collected. The follow-up assessment included survival, rejection, infectious complications, renal replacement therapy (RRT), heart failure decompensation, hospitalizations, outpatient visits, and changes in pharmacotherapy. Cox proportional hazards regression and Receiver Operating Characteristic (ROC) analyses were also performed to assess factors associated with 12-month mortality. Results: The study population comprised 82 (82%) men and 18 (18%) women with a median age of 54 years (IQR, 45–64). The in-hospital course was characterized by substantial early morbidity: 17 patients (17%) died during the index hospitalization, with a median time to death of 17 days (IQR, 3–78). RRT was required in 44% of patients. Among hospital survivors, the median length of hospital stay was 43 days and the median ICU stay was 7 days. During the 12-month follow-up, clinically significant cellular graft rejection (grade ≥ 3) occurred at least once in 51% of patients, infectious complications in 45%, and one patient underwent retransplantation. The twelve-month all-cause mortality was 23%. Patients had a mean of 8 planned hospitalizations, 0.4 unplanned admissions, and 1.3 outpatient visits per patient. Exploratory analyses identified possible associations between selected pre-transplant variables and 12-month mortality. Conclusions: The first 100 HTx recipients treated at the newly established center experienced a clinically demanding in-hospital course, with a 17% in-hospital mortality. After discharge, the first year remained characterized by frequent cellular rejection incidence, and infectious complications. The twelve-month survival was 77%. These findings provide a comprehensive description of the early in-hospital and 12-month clinical course of a newly established Htx program.