Skip to main content

Advertisement

SpringerLink
Log in

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

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. 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.

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  3. 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  CAS  Google Scholar 

  4. 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  CAS  Google Scholar 

  5. 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.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  8. 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.

    Article  Google Scholar 

  9. 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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

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

    Google Scholar 

  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 735–736

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

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

    PubMed  CAS  Google Scholar 

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

    PubMed  CAS  Google Scholar 

Download references

Conflict of Interest

The authors disclose no conflicts.

Grant Support

This study was supported by a grant of the Korea Healthcare Technology R&D Project, Ministry for Health, Welfare & Family Affairs, Republic of Korea (A084120).

Author information

Authors and Affiliations

  1. Department of Surgery, Yonsei University College of Medicine, 134, Shinchon-dong, Seodaemun-gu, Seoul, 120-752, South Korea

    Sung Hoon Kim, Yoon Dae Han, Jae Gil Lee, Gi Hong Choi, Jin Sub Choi & Kyung Sik Kim

  2. Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea

    Do Young Kim

  3. Department of Surgery, Korea University College of Medicine, Seoul, South Korea

    Sae Byeol Choi

Authors
  1. Sung Hoon Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yoon Dae Han
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jae Gil Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Do Young Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sae Byeol Choi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Gi Hong Choi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jin Sub Choi
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Kyung Sik Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kyung Sik Kim.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kim, S.H., Han, Y.D., Lee, J.G. et al. MELD-Based Indices as Predictors of Mortality in Chronic Liver Disease Patients Who Undergo Emergency Surgery with General Anesthesia. J Gastrointest Surg 15, 2029–2035 (2011). https://doi.org/10.1007/s11605-011-1669-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-011-1669-5

Keywords

Search

Navigation