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

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

Research output: Contribution to journalArticle

10 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)2029-2035
Number of pages7
JournalJournal of Gastrointestinal Surgery
Volume15
Issue number11
DOIs
Publication statusPublished - 2011 Nov 1

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End Stage Liver Disease
General Anesthesia
Liver Diseases
Emergencies
Chronic Disease
Mortality
Liver
Ambulatory Surgical Procedures
Medical Records
Multivariate Analysis
Sodium
Morbidity

Keywords

  • Chronic liver disease
  • CTP score
  • Emergency
  • MELD-based indices
  • Surgery

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

Cite this

MELD-Based Indices as Predictors of Mortality in Chronic Liver Disease Patients Who Undergo Emergency Surgery with General Anesthesia. / Kim, Sung Hoon; Han, Yoon Dae; Lee, Jae Gil; Kim, Do Young; Choi, Sae-Byeol; Choi, Gi Hong; Choi, Jin Sub; Kim, Kyung Sik.

In: Journal of Gastrointestinal Surgery, Vol. 15, No. 11, 01.11.2011, p. 2029-2035.

Research output: Contribution to journalArticle

Kim, Sung Hoon ; Han, Yoon Dae ; Lee, Jae Gil ; Kim, Do Young ; Choi, Sae-Byeol ; Choi, Gi Hong ; Choi, Jin Sub ; Kim, Kyung Sik. / MELD-Based Indices as Predictors of Mortality in Chronic Liver Disease Patients Who Undergo Emergency Surgery with General Anesthesia. In: Journal of Gastrointestinal Surgery. 2011 ; Vol. 15, No. 11. pp. 2029-2035.
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N2 - 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.

AB - 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.

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