Top

Published in:

01-11-2011 | Original Article

MELD-Based Indices as Predictors of Mortality in Chronic Liver Disease Patients Who Undergo Emergency Surgery with General Anesthesia

Authors: Sung Hoon Kim, Yoon Dae Han, Jae Gil Lee, Do Young Kim, Sae Byeol Choi, Gi Hong Choi, Jin Sub Choi, Kyung Sik Kim

Published in: Journal of Gastrointestinal Surgery | Issue 11/2011

Abstract

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.

Powell-Jackson P, Greenway B, Williams R. Adverse effects of exploratory laparotomy in patients with unsuspected liver disease. Br J Surg 1982;69(8):449–451.PubMedCrossRef

Friedman LS. The risk of surgery in patients with liver disease. Hepatology 1999;29(6):1617–1623.PubMedCrossRef

Gholson CF, Provenza JM, Bacon BR. Hepatologic considerations in patients with parenchymal liver disease undergoing surgery. Am J Gastroenterol 1990;85(5):487–496.PubMed

Holt C, Csete M, Martin P. Hepatotoxicity of anesthetics and other central nervous system drugs. Gastroenterol Clin North Am 1995;24(4):853–874.PubMed

Hoteit MA, Ghazale AH, Bain AJ, et al. Model for end-stage liver disease score versus Child score in predicting the outcome of surgical procedures in patients with cirrhosis. World J Gastroenterol 2008;14(11):1774–1780.PubMedCrossRef

Teh SH, Nagorney DM, Stevens SR, et al. Risk Factors for Mortality After Surgery in Patients With Cirrhosis. Gastroenterology 2007;132(4):1261–1269.PubMedCrossRef

Biggins SW, Kim WR, Terrault NA, et al. Evidence-Based Incorporation of Serum Sodium Concentration Into MELD. Gastroenterology 2006;130(6):1652–1660.PubMedCrossRef

Biggins SW, Rodriguez HJ, Baccheti P, et al. Would the addition of serum sodium to the meld score increase its accuracy in predicting mortality of cirrhotic patients? Evidence-Based Gastroenterology 2005;6(2):56–58.CrossRef

Ruf AE, Kremers WK, Chavez LL, Descalzi VI, Podesta LG, Villamil FG. Addition of serum sodium into the MELD score predicts waiting list mortality better than MELD alone. Liver Transplantation 2005;11(3):336–343.PubMedCrossRef

10.

Costa B, Castro Sousa F, Serôdio M, Carvalho C. Value of MELD and MELD-Based Indices in Surgical Risk Evaluation of Cirrhotic Patients: Retrospective Analysis of 190 Cases. World Journal of Surgery 2009;33(8):1711–1719.PubMedCrossRef

11.

Ziser A, Plevak DJ, Wiesner RH, Rakela J, Offord KP, Brown DL. Morbidity and mortality in cirrhotic patients undergoing anesthesia and surgery. Anesthesiology 1999;90(1):42–53.PubMedCrossRef

12.

Freeman RB. MELD: the holy grail of organ allocation? Journal of Hepatology 2005;42(1):16–20.PubMedCrossRef

13.

Huo T-I, Wang Y-W, Yang Y-Y, et al. Model for end-stage liver disease score to serum sodium ratio index as a prognostic predictor and its correlation with portal pressure in patients with liver cirrhosis. Liver International 2007;27(4):498–506.PubMedCrossRef

14.

Garrison RN, Cryer HM, Howard DA, Polk HC, Jr. Clarification of risk factors for abdominal operations in patients with hepatic cirrhosis. Ann Surg 1984;199(6):648–655.PubMedCrossRef

15.

Child CG, Turcotte JG (1964) Surgery and portal hypertension. In: Child CG (ed) The liver and portal hypertension. Saunders, Philadelphia

16.

Mansour A, Watson W, Shayani V, Pickleman J. Abdominal operations in patients with cirrhosis: still a major surgical challenge. Surgery. 1997; 122(4):730–735; discussion 735–736PubMedCrossRef

17.

Pugh RNH, Murray-Lyon IM, Dawson JL, Pietroni MC, Williams R. Transection of the oesophagus for bleeding oesophageal varices. British Journal of Surgery 1973;60(8):646–649.PubMedCrossRef

18.

Castera L, Pauwels A, Levy VG. Prognostic indicators in patients with liver cirrhosis admitted to an intensive care unit. Gastroenterol Clin Biol 1996;20(3):263–268.PubMed

19.

Malinchoc M, Kamath PS, Gordon FD, Peine CJ, Rank J, Borg PCJt. A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts. Hepatology 2000;31(4):864–871.PubMedCrossRef

20.

Jr RBF, Wiesner RH, Harper A, et al. The new liver allocation system: Moving toward evidence-based transplantation policy. Liver Transplantation 2002;8(9):851–858.CrossRef

21.

Cucchetti A, Ercolani G, Cescon M, et al. Recovery from liver failure after hepatectomy for hepatocellular carcinoma in cirrhosis: meaning of the model for end-stage liver disease. J Am Coll Surg 2006;203(5):670–676.PubMedCrossRef

22.

Delis SG, Bakoyiannis A, Biliatis I, Athanassiou K, Tassopoulos N, Dervenis C. Model for end-stage liver disease (MELD) score, as a prognostic factor for post-operative morbidity and mortality in cirrhotic patients, undergoing hepatectomy for hepatocellular carcinoma. HPB 2009;11(4):351–357.PubMedCrossRef

23.

Farnsworth N, Fagan SP, Berger DH, Awad SS. Child-Turcotte-Pugh versus MELD score as a predictor of outcome after elective and emergent surgery in cirrhotic patients. Am J Surg 2004;188(5):580–583.PubMedCrossRef

24.

Lv XH, Liu HB, Wang Y, Wang BY, Song M, Sun MJ. Validation of model for end-stage liver disease score to serum sodium ratio index as a prognostic predictor in patients with cirrhosis. Journal of Gastroenterology and Hepatology 2009;24(9):1547–1553.PubMedCrossRef

25.

Suman A, Barnes DS, Zein NN, Levinthal GN, Connor JT, Carey WD. Predicting outcome after cardiac surgery in patients with cirrhosis: A comparison of Child-Pugh and MELD scores. Clinical Gastroenterology and Hepatology 2004;2(8):719–723.PubMedCrossRef

26.

Telem DA, Schiano T, Goldstone R, et al. Factors That Predict Outcome of Abdominal Operations in Patients With Advanced Cirrhosis. Clinical Gastroenterology and Hepatology 2010;8(5):451–457.PubMedCrossRef

27.

Henderson JM. What Are the Risks of General Surgical Abdominal Operations in Patients With Cirrhosis? Clinical Gastroenterology and Hepatology 2010;8(5):399–400.PubMedCrossRef

28.

Bosch J, García-Pagán JC. Complications of cirrhosis. I. Portal hypertension. Journal of Hepatology. 2000; 32(SUPPL.1):141–156PubMedCrossRef

29.

Yoo HY, Edwin D, Thuluvath PJ. Relationship of the model for End-Stage Liver Disease (MELD) scale to hepatic encephalopathy, as defined by electroencephalography and neuropsychometric testing, and ascites. American Journal of Gastroenterology 2003;98(6):1395–1399.PubMedCrossRef

30.

Albillos A, Colombato LA, Groszmann RJ. Vasodilatation and sodium retention in prehepatic portal hypertension. Gastroenterology 1992;102(3):931–935.PubMed

31.

Bosch J, Arroyo V, Betriu A. Hepatic hemodynamics and the renin-angiotensin-aldosterone system in cirrhosis. Gastroenterology 1980;78(1):92–99.PubMed

Title: MELD-Based Indices as Predictors of Mortality in Chronic Liver Disease Patients Who Undergo Emergency Surgery with General Anesthesia
Authors: Sung Hoon Kim
Yoon Dae Han
Jae Gil Lee
Do Young Kim
Sae Byeol Choi
Gi Hong Choi
Jin Sub Choi
Kyung Sik Kim
Publication date: 01-11-2011
Publisher: Springer-Verlag
Published in: Journal of Gastrointestinal Surgery / Issue 11/2011
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-011-1669-5

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

MELD-Based Indices as Predictors of Mortality in Chronic Liver Disease Patients Who Undergo Emergency Surgery with General Anesthesia

Abstract

Background

Method

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Method

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 11/2011

Outcomes of Right vs. Left Colectomy for Colon Cancer

Patti MG, Herbella FA. Fundoplication After Laparoscopic Heller Myotomy for Esophageal Achalasia: What Type? J Gastrointest Surg. 2010 Sept.;14(9):1453–8

Preoperative Detection of Novel Predictors for Lymph Node Metastasis in Early Colorectal Cancer

A Systematic Review and Meta-analysis of Survival and Surgical Outcomes Following Neoadjuvant Chemoradiotherapy for Pancreatic Cancer

The Clinical Significance of Lymphovascular and Perineural Invasions in Patients with Colorectal Cancer

Management of Gastrointestinal Leaks After Minimally Invasive Esophagectomy: Conventional Treatments vs. Endoscopic Stenting