YKL-40: Revolutionizing cardiac risk prediction and therapy in liver transplantation

Table 4 Predictive tools and scoring systems designed to assess cardiovascular risk in liver transplant recipients

Scoring system	Description	Risk categories	Clinical factors considered	Applicability to LT patients
RCRI	Developed for the general surgical population to predict perioperative cardiac complications	Low risk: 0-1 factors. Moderate risk: 2 factors. High risk: ≥ 3 factors	History of IHD. History of CHF. History of CVD. Insulin-dependent DM. CKD (creatinine > 2 mg/dL). Undergoing high-risk surgery	Limitations: Does not account for cirrhosis-specific hemodynamic alterations, potentially underestimating risk in LT candidates
CVROL score	Tailored specifically for LT candidates to predict post-LT cardiovascular events	Low risk: Score ≤ 2. Moderate risk: Score 3-5. High risk: Score ≥ 6	Age history of CAD DM hypertension Smoking status LVH elevated serum troponin levels	Strengths: Incorporates factors prevalent in LT candidates, providing a more accurate risk assessment
Framingham risk score	Estimates 10-year cardiovascular risk in the general population	Low risk: < 10% risk. Intermediate risk: 10%-20% risk. High risk: > 20% risk	Age gender total cholesterol. HDL cholesterol. SBP treatment for hypertension. Smoking status	Limitations: May not accurately reflect the altered cardiovascular physiology in LT candidates
CAR-OLT score	Developed to predict cardiovascular complications post-LT, incorporating cirrhosis-specific factors	Low risk: Score ≤ 10. Moderate risk: Score 11-15. High risk: Score > 15	Age history of CAD DM Beta-blocker use. Serum creatinine. LVH. Non-sinus rhythm. Low serum albumin	Strengths: Addresses cirrhosis-specific hemodynamic changes, offering improved predictive accuracy for LT recipients
CAD-LT score	Predicts the risk of significant CAD in LT candidates	Low risk: Score ≤ 2. High risk: Score ≥ 3	Age DM hypertension. Smoking status. Dyslipidemia	Strengths: Assists in identifying LT candidates at higher risk for CAD, guiding further cardiac evaluation

CAD: Coronary artery disease; CAD-LT: Coronary artery disease in liver transplantation; CAR-OLT: Cardiac risk in orthotopic liver transplantation; CHF: Congestive heart failure; CKD: Chronic kidney disease; CVD: Cerebrovascular disease; CVROL: Cardiovascular risk in orthotopic liver transplantation; DM: Diabetes mellitus; HDL: High-density lipoprotein; IHD: Ischemic heart disease; LVH: Left ventricular hypertrophy; post-LT: Post liver transplantation; RCRI: Revised cardiac risk index; SBP: Systolic blood pressure.