Premium
Predictors of mortality in cirrhotic patients undergoing extrahepatic surgery: comparison of C hild– T urcotte– P ugh and model for end‐stage liver disease‐based indices
Author(s) -
Kim Dong Hyun,
Kim Sung Hoon,
Kim Kyung Sik,
Lee Woo Jung,
Kim Nam Kyu,
Noh Sung Hoon,
Kim Choong Bai
Publication year - 2014
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/ans.12198
Subject(s) - medicine , cirrhosis , model for end stage liver disease , liver disease , odds ratio , mortality rate , hazard ratio , surgery , gastroenterology , confidence interval , elective surgery , stage (stratigraphy) , risk of mortality , liver transplantation , paleontology , biology , transplantation
Abstract Background Underlying liver cirrhosis is associated with high morbidity and mortality after surgery. Previous studies have reported conflicting results about the value of C hild– T urcotte– P ugh ( CTP ) and model for end‐stage liver disease ( MELD ) scores as predictors of post‐operative mortality. This study was designed to compare the capacities of CTP , MELD and MELD ‐based indices in predicting mortality for patients with liver cirrhosis who underwent elective extrahepatic surgery. Methods The medical records of 79 patients with liver cirrhosis who underwent elective extrahepatic surgery under general anaesthesia from D ecember 2000 to D ecember 2009 were reviewed retrospectively. Results The median follow‐up period was 21 months, and the mortality rate was 24.1% ( n = 19). Among the 19 mortalities, nine (11.4%) occurred while the patient was hospitalized after surgery. Intraoperative transfusion amount (≥700 mL; odds ratio 6.294, P = 0.004) and the integrated MELD score (≥34; odds ratio 6.654, P = 0.007) were significantly correlated with post‐operative mortality. CTP score (hazard ratio 1.575, P = 0.012) was significantly correlated with overall mortality. Conclusions Integrated MELD may be a more accurate predictor of operative mortality in cirrhotic patients undergoing extrahepatic surgery than CTP and other MELD ‐ N a based indices. However, overall mortality may be reflected more accurately by CTP score. Further large‐scale study will be needed to validate this result.