OBJECTIVE: There are few data assessing factors, which identify patients with liver cirrhosis (LC) facing high risk for open-heart surgery. We sought to compare the Model for End-Stage Liver Disease (MELD) score, the Child-Turcotte-Pugh (CTP) classification and the European system for cardiac operative risk evaluation (EuroSCORE) for risk prediction in cirrhotic patients. METHODS: Fifty-seven consecutive patients with non-cardiac LC, who underwent open-heart surgery with the use of cardiopulmonary bypass between 1998 and 2008, were studied at our institution. Potential preoperative predictors of outcome, as well as preoperative MELD score, CTP classification and EuroSCORE were calculated. The primary study end points were all-cause in-hospital and long-term mortality. RESULTS: MELD score and CTP classification both differed significantly between survivors and non-survivors for in-hospital (P<0.0001) and long-term mortality (P<0.0001). Univariate predictors of in-hospital mortality were emergency surgery (odds ratio (OR), 4.9; 95% confidence interval (CI), 1.2-20.6; P=0.03), ascites (OR, 7.2; 95% CI, 2.0-25.5; P=0.002), total serum protein (OR, 0.4; 95% CI, 0.2-0.8; P=0.01), CTP class (OR, 5.5; 95% CI, 1.4-21.5; P=0.04) and MELD score (OR, 1.4; 95% CI, 1.1-1.6; P=0.001). Multivariable exact logistic regression analyses revealed MELD score (OR, 1.3; 95% CI, 1.005-1.6; P=0.04) as the only independent factor associated with in-hospital mortality. Receiver operating characteristic curve (ROC) analysis showed MELD score to be highly predictive with an optimal cut-off value of 13.5 (sensitivity: 82.0%, specificity: 78.5%) for postoperative in-hospital mortality (area under curve (AUC): 85.1 ± 0.05%) and superior compared to the CTP classification (AUC: 75.7±0.08%) and EuroSCORE (AUC: 65.9 ± 0.08%). CONCLUSIONS: The mortality of patients with liver cirrhosis undergoing open-heart surgery progressively increases with the severity of liver dysfunction. Therefore, the MELD score most reliably identifies those cirrhotic patients who are at high risk for open-heart surgery.
OBJECTIVE: There are few data assessing factors, which identify patients with liver cirrhosis (LC) facing high risk for open-heart surgery. We sought to compare the Model for End-Stage Liver Disease (MELD) score, the Child-Turcotte-Pugh (CTP) classification and the European system for cardiac operative risk evaluation (EuroSCORE) for risk prediction in cirrhotic patients. METHODS: Fifty-seven consecutive patients with non-cardiac LC, who underwent open-heart surgery with the use of cardiopulmonary bypass between 1998 and 2008, were studied at our institution. Potential preoperative predictors of outcome, as well as preoperative MELD score, CTP classification and EuroSCORE were calculated. The primary study end points were all-cause in-hospital and long-term mortality. RESULTS: MELD score and CTP classification both differed significantly between survivors and non-survivors for in-hospital (P<0.0001) and long-term mortality (P<0.0001). Univariate predictors of in-hospital mortality were emergency surgery (odds ratio (OR), 4.9; 95% confidence interval (CI), 1.2-20.6; P=0.03), ascites (OR, 7.2; 95% CI, 2.0-25.5; P=0.002), total serum protein (OR, 0.4; 95% CI, 0.2-0.8; P=0.01), CTP class (OR, 5.5; 95% CI, 1.4-21.5; P=0.04) and MELD score (OR, 1.4; 95% CI, 1.1-1.6; P=0.001). Multivariable exact logistic regression analyses revealed MELD score (OR, 1.3; 95% CI, 1.005-1.6; P=0.04) as the only independent factor associated with in-hospital mortality. Receiver operating characteristic curve (ROC) analysis showed MELD score to be highly predictive with an optimal cut-off value of 13.5 (sensitivity: 82.0%, specificity: 78.5%) for postoperative in-hospital mortality (area under curve (AUC): 85.1 ± 0.05%) and superior compared to the CTP classification (AUC: 75.7±0.08%) and EuroSCORE (AUC: 65.9 ± 0.08%). CONCLUSIONS: The mortality of patients with liver cirrhosis undergoing open-heart surgery progressively increases with the severity of liver dysfunction. Therefore, the MELD score most reliably identifies those cirrhotic patients who are at high risk for open-heart surgery.
Authors: Nadim Mahmud; Zachary Fricker; Marina Serper; David E Kaplan; Kenneth D Rothstein; David S Goldberg Journal: Liver Int Date: 2019-06-17 Impact factor: 5.828
Authors: Robert B Hawkins; Bree Ann C Young; J Hunter Mehaffey; Alan M Speir; Mohammed A Quader; Jeffrey B Rich; Gorav Ailawadi Journal: Ann Thorac Surg Date: 2019-01-09 Impact factor: 4.330
Authors: Muhammad Z Khan; Muhammad U Khan; Muhammad Bilal Munir; Safi U Khan; Mohammed Osman; Sudarshan Balla Journal: Catheter Cardiovasc Interv Date: 2020-03-04 Impact factor: 2.692
Authors: Juan C Lopez-Delgado; Francisco Esteve; Casimiro Javierre; Josep L Ventura; Rafael Mañez; Elisabet Farrero; Herminia Torrado; David Rodríguez-Castro; Maria L Carrio Journal: World J Hepatol Date: 2015-04-18
Authors: Juan Carlos Lopez-Delgado; Francisco Esteve; Casimiro Javierre; Xose Perez; Herminia Torrado; Maria L Carrio; David Rodríguez-Castro; Elisabet Farrero; Josep Lluís Ventura Journal: Interact Cardiovasc Thorac Surg Date: 2012-12-12