BACKGROUND: Underlying chronic liver disease is associated with high morbidity and mortality after emergency surgery, which complicates clinical decisions over performing such surgery. In addition, the Child-Turcotte-Pugh (CTP) score is limited in its ability to predict postoperative residual liver function. This study was designed to determine whether the scores of the Model for End-stage Liver Disease (MELD)-based indices are effective predictors of mortality following emergency surgery in patients with chronic liver disease. METHOD: Medical records of 53 chronic liver disease patients who underwent emergency surgery under general anesthesia from 2001 to 2008 were analyzed retrospectively. RESULTS: Median preoperative CTP score was 6 (5-12); MELD, 11 (6-33); MELD-Na, 15 (7-34); integrated MELD (iMELD), 33 (14-64); and MELD to sodium ratio, 8 (4-24). During a median 11-month follow-up period, 19 (35.8%) patients died. Five of them (26.3%) had operative mortality (i.e., mortality within 30 days after surgery). On multivariate analysis, CTP class C was correlated with operative mortality, and estimated blood loss above 300 ml and the iMELD score above 35 were significantly correlated with overall mortality. CONCLUSIONS: iMELD reflects underlying liver function and predicts overall mortality more accurately than CTP and other MELD-based indices scores do in chronic liver disease patients after emergency surgery with general anesthesia.
BACKGROUND: Underlying chronic liver disease is associated with high morbidity and mortality after emergency surgery, which complicates clinical decisions over performing such surgery. In addition, the Child-Turcotte-Pugh (CTP) score is limited in its ability to predict postoperative residual liver function. This study was designed to determine whether the scores of the Model for End-stage Liver Disease (MELD)-based indices are effective predictors of mortality following emergency surgery in patients with chronic liver disease. METHOD: Medical records of 53 chronic liver diseasepatients who underwent emergency surgery under general anesthesia from 2001 to 2008 were analyzed retrospectively. RESULTS: Median preoperative CTP score was 6 (5-12); MELD, 11 (6-33); MELD-Na, 15 (7-34); integrated MELD (iMELD), 33 (14-64); and MELD to sodium ratio, 8 (4-24). During a median 11-month follow-up period, 19 (35.8%) patients died. Five of them (26.3%) had operative mortality (i.e., mortality within 30 days after surgery). On multivariate analysis, CTP class C was correlated with operative mortality, and estimated blood loss above 300 ml and the iMELD score above 35 were significantly correlated with overall mortality. CONCLUSIONS: iMELD reflects underlying liver function and predicts overall mortality more accurately than CTP and other MELD-based indices scores do in chronic liver diseasepatients after emergency surgery with general anesthesia.
Authors: Swee H Teh; David M Nagorney; Susanna R Stevens; Kenneth P Offord; Terry M Therneau; David J Plevak; Jayant A Talwalkar; W Ray Kim; Patrick S Kamath Journal: Gastroenterology Date: 2007-01-25 Impact factor: 22.682
Authors: Amitabh Suman; David S Barnes; Nizar N Zein; Gavin N Levinthal; Jason T Connor; William D Carey Journal: Clin Gastroenterol Hepatol Date: 2004-08 Impact factor: 11.382
Authors: Elliot B Tapper; Vilas Patwardhan; Laura M Mazer; Byron Vaughn; Gail Piatkowski; Amy R Evenson; Raza Malik Journal: J Gastrointest Surg Date: 2014-08-05 Impact factor: 3.452