Predicting outcome after cardiac surgery in patients with cirrhosis: A comparison of Child-Pugh and MELD scores

Suman, Amitabh; Barnes, David S.; Zein, Nizar N.; Levinthal, Gavin; Connor, Jason T.; Carey, William D.

doi:10.1016/s1542-3565(04)00296-4

Cited by 235 publications

(179 citation statements)

References 12 publications

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“…56 This MELD cutoff of 8 for carrying out hepatic resection for HCC has been confirmed by a study from Italy. 57 The utility of MELD in determining postoperative mortality has also been confirmed in patients undergoing cardiac surgery, 58 as well as in abdominal operations including cholecystectomy, [59][60][61] However, MELD was an inaccurate predictor of mortality in patients without cirrhosis undergoing liver resection. 62 In our experience, MELD, the ASA physical status, and age can be used to determine mortality following surgery independent of the procedure performed.…”

Section: Meld In the Management Of Patients With Esldmentioning

confidence: 99%

The model for end-stage liver disease (MELD)

2007

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The Model for End-stage Liver Disease (MELD) was initially created to predict survival in patients with complications of portal hypertension undergoing elective placement of transjugular intrahepatic portosystemic shunts. The MELD which uses only objective variables was validated subsequently as an accurate predictor of survival among different populations of patients with advanced liver disease. The major use of the MELD score has been in allocation of organs for liver transplantation. However, the MELD score has also been shown to predict survival in patients with cirrhosis who have infections, variceal bleeding, as well as in patients with fulminant hepatic failure and alcoholic hepatitis. MELD may be used in selection of patients for surgery other than liver transplantation and in determining optimal treatment for patients with hepatocellular carcinoma who are not candidates for liver trans- becoming the standard by which priorities in donor liver allocation were determined. Since the score was first derived in a relatively small number of patients undergoing the transjugular intrahepatic portosystemic shunts (TIPS) procedure, it has been validated in many different populations of patients with liver disease. Within a relatively short period of time, MELD became a common metric by which the severity of liver disease could be accurately described.In this paper, we review the initial development and validation of the MELD score, its application in organ allocation and management of patients with a variety of liver conditions, its strengths and limitation, and current and future efforts to refine and improve it further. Creation and Validation of MELDMELD was initially created to predict survival following elective placement of TIPS. 1 The model was subsequently validated as a predictor of survival in several cohorts of patients with varying levels of liver disease severity (e.g., hospitalized and ambulatory patients), as well as patients of geographically and temporally diverse origin. 2 The survival model was initially termed the "Mayo End-Stage Liver Disease" or "MELD" model to acknowledge the affiliation of the investigators who created the model. During discussions leading to the establishment of MELD as the basis for prioritization of organs for liver transplantation, 3,4 we changed the name to "Model for End-Stage Liver Disease" which maintained the acronym "MELD", but removed the association with a particular institution, a process that was thought would lead to wider acceptance of the model. MELD incorporates 3 widely available laboratory variables including the international normalized ratio (INR), serum creatinine, and serum bilirubin. The original mathematical formula for MELD is: MELD ϭ 9.57 ϫ log e (creatinine) ϩ 3.78 ϫ Log e (total bilirubin) ϩ 11.2 ϫ Log e (INR) ϩ 6.43.The score can be calculated on handheld computing devices, and is available at www.mayoclinic.org/gi-rst/ mayomodel5.html. When the model was initially created the etiology of cirrhosis was also included. In the TIPS

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Section: Meld In the Management Of Patients With Esldmentioning

confidence: 99%

The model for end-stage liver disease (MELD)

2007

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“…In two retrospective series of patients who underwent surgery requiring cardiopulmonary bypass, relatively low mortality rates were observed in those with Child class A cirrhosis (0% [ 0 ⁄10] and 3% [ 1 ⁄31]) but rates were markedly increased in those with Child class B (42-50%) and C (100%, n ϭ 2) cirrhosis. In addition, more than 75% of Child class B and C patients experienced hepatic decompensation (27,28). Increased mortality is also predicted by an increased MELD score.…”

Section: Cardiac Surgerymentioning

confidence: 99%

Surgery in the Patient with Liver Disease

O’Leary

Yachimski

Friedman

2009

Clinics in Liver Disease

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“…Therefore, open heart surgery should be avoided for patients with C-P grade C, and cardiac operation on the beating heart is recommended for patients with C-P grade B [224] . The results of another study led to the recommendation that patients with a C-P score > 7 avoid cardiac surgery involving cardiopulmonary bypass [225] . In summary, surgery should be avoided for patients with acute hepatitis.…”

Section: Risk Of Surgery In Patients With Liver Diseasesmentioning

confidence: 99%