Clinical

MELD score predicts mortality after surgery in patients with cirrhosis

Last Updated: 2007-05-08 14:07:19 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Among patients with cirrhosis who undergo various surgical procedures, short-term and long-term mortality is predicted by the severity of liver disease, as reflected by the MELD (Model for End-stage liver Disease) score, researchers report.

Comorbid conditions, as determined by the American Society of Anesthesiologists (ASA) physical status classification, and age are also important factors, they report in the April issue of Gastroenterology.

"Current methods of predicting risk of postoperative mortality in patients with cirrhosis are suboptimal," Dr. Patrick S. Kamath and colleagues from the Mayo Clinic, Rochester, Minnesota, write. "The utility of the Model for End-stage Liver Disease in predicting mortality after surgery other than liver transplantation is unknown."

The researchers examined mortality in 772 patients with cirrhosis who underwent major digestive (n = 586), orthopedic (n = 107), or cardiovascular (n = 79) surgery. Two control groups of patients with cirrhosis included 303 subjects who underwent minor surgical procedures and 562 ambulatory patients.

The risk for mortality was increased up to 90 days among patients who underwent major surgery. Results of multivariable analysis demonstrated that the only independent predictors of mortality throughout follow-up were MELD score, ASA class, and age.

For a MELD score of less than 8, 30-day mortality was 5.7%. The rates for scores of 8 to 11, 12 to 15, 16 to 20, 21 to 25, and 26 and higher were 10.3%, 25.4%, 44.0%, 53.8%, and 90.0%, respectively. The team notes that the association between MELD score and mortality persisted throughout the 20-year postoperative period.

"These factors can be used in determining operative mortality risk," Dr. Kamath's team concludes, "and whether elective surgical procedures can be delayed until after liver transplantation."

Gastroenterology 2007;132:1261-1269.