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MELD-based indices as predictors of mortality in chronic liver disease patients who undergo emergency surgery with general anesthesia

Authors
 Sung Hoon Kim  ;  Yoon Dae Han  ;  Jae Gil Lee  ;  Do Young Kim  ;  Sae Byeol Choi  ;  Gi Hong Choi  ;  Jin Sub Choi  ;  Kyung Sik Kim 
Citation
 JOURNAL OF GASTROINTESTINAL SURGERY, Vol.15(11) : 2029-2035, 2011 
Journal Title
JOURNAL OF GASTROINTESTINAL SURGERY
ISSN
 1091-255X 
Issue Date
2011
MeSH
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Anesthesia, General/adverse effects ; Area Under Curve ; Blood Loss, Surgical* ; Blood Volume ; Chronic Disease ; Emergency Treatment/mortality* ; End Stage Liver Disease/physiopathology ; Female ; Humans ; Length of Stay ; Liver Diseases/complications ; Liver Diseases/mortality* ; Male ; Middle Aged ; Multivariate Analysis ; Predictive Value of Tests ; Proportional Hazards Models ; ROC Curve ; Retrospective Studies ; Severity of Illness Index ; Surgical Procedures, Operative/mortality* ; Young Adult
Keywords
Chronic liver disease ; Emergency ; Surgery MELD-based indices ; CTP score
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.
Full Text
http://link.springer.com/article/10.1007%2Fs11605-011-1669-5
DOI
10.1007/s11605-011-1669-5
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Kyung Sik(김경식) ORCID logo https://orcid.org/0000-0001-9498-284X
Kim, Do Young(김도영)
Kim, Sung Hoon(김성훈)
Lee, Jae Gil(이재길) ORCID logo https://orcid.org/0000-0002-1148-8035
Choi, Gi Hong(최기홍) ORCID logo https://orcid.org/0000-0002-1593-3773
Choi, Jin Sub(최진섭)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/94561
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