Value of MELD and MELD‐Based Indices in Surgical Risk Evaluation of Cirrhotic Patients: Retrospective Analysis of 190 Cases

• DOI: 10.1007/s00268-009-0093-4
• Publication Date: 2009-06-09T12:40:01Z
• Authors: Beatriz P. Costa; F. Castro Sousa; Marco Serôdio; César Carvalho
• Keywords: Liver disease

AbstractBackgroundRecent studies have suggested that the Model for End‐Stage Liver Disease (MELD) may represent a promising alternative to the Child‐Turcotte‐Pugh classification as a predictive factor of operative mortality and morbidity. This study was designed to evaluate the value of MELD and four MELD‐based indices (iMELD: integrated MELD; MESO: MELD to sodium ratio; MELD‐Na: MELD with incorporation of sodium; MELD‐XI: MELD excluding the International Normalized Ratio) in the quantification of surgical risk for patients with cirrhosis and compare its prognostic value with the Child‐Turcotte‐Pugh classification and two derived scores (proposed by Huo and Giannini, respectively).MethodsA retrospective study of 190 patients with cirrhosis, operated on in our department between 1993 and 2008, was undertaken.ResultsForty‐three percent of patients were included in Child‐Turcotte‐Pugh A class, and their mean MELD score was 12.2 ± 4.9 (range, 6.4–35.2). Mortality and morbidity rates were 13% and 24%, respectively. In global analysis of mortality, MELD‐based indices presented an acceptable prognostic performance (auROC = 71–77%), similar to the three analyzed Child‐Turcotte‐Pugh‐derived scores. iMELD demonstrated the highest prognostic capacity (auROC = 77%; 95% confidence interval (CI), 66–88; p = 0.0001); operative death probability was 4% (95% CI, 3.6–4.4) when the score was inferior to 35, 16.1% (95% CI, 14.4–17.9) between 35 and 45, and 50.1% (95% CI, 42.2–58.1) when superior to 45. In elective surgical procedures, iMELD represented a useful prognostic factor of operative mortality (auROC = 80%; 95% CI, 63–97; p = 0.044) with significant correlation and better accuracy then MELD and Child‐Turcotte‐Pugh‐derived indices.ConclusionsIn this study, iMELD was a useful predictive parameter of operative mortality for patients with cirrhosis submitted to elective procedures. Further studies are necessary to define the relevance of MELD‐based indices in the individual surgical risk evaluation.