Value of MELD and MELD-based indices in surgical risk evaluation of cirrhotic patients: retrospective analysis of 190 cases

Abstract

Background: Recent 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).

Methods: A retrospective study of 190 patients with cirrhosis, operated on in our department between 1993 and 2008, was undertaken.

Results: Forty-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.

Conclusions: In 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.