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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 ; Kyung Sik Kim ; Jin Sub Choi ; Gi Hong Choi ; Sae Byeol Choi ; Do Young Kim ; Jae Gil Lee 
Citation
 Journal of Gastrointestinal Surgery, Vol.15(11) : 2029~2035, 2011 
Journal Title
 Journal of Gastrointestinal Surgery 
ISSN
 1091-255X 
Issue Date
2011
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.
URI
http://ir.ymlib.yonsei.ac.kr/handle/22282913/94561
DOI
10.1007/s11605-011-1669-5
Appears in Collections:
1. 연구논문 > 1. College of Medicine > Dept. of Surgery
1. 연구논문 > 1. College of Medicine > Dept. of Internal Medicine
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Link
 http://link.springer.com/article/10.1007%2Fs11605-011-1669-5
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