Mortality after surgery in patients with liver cirrhosis: comparison of Child-Turcotte-Pugh, MELD and MELDNa score

Abstract

Background/aims: This study was aimed at determining the postoperative mortality in patients with cirrhosis by Child-Turcotte-Pugh (CTP), Model for End-stage Liver Disease score (MELD), and Model for End-stage Liver Disease and Serum Sodium Concentration score (MELDNa) systems and to compare the predictability of the scoring systems.

Methods: Analysis was performed on clinical records of 490 patients with cirrhosis who underwent surgery under general anesthesia from January 2003 to December 2008.

Results: (i) Ninety-day mortality in patients with CTP A, B, and C class were 2.1, 22.1 and 54.5%, respectively. (ii) Ninety-day mortality according to MELD score was as follows: 6-9, 3.5%; 10-14, 8.9%; 15-19, 14.3%; 20-24, 12.5%; and ≥25, 63.6%. (iii) Ninety-day mortality according to MELDNa score was as follows: 6-9, 1.9%; 10-14, 6.2%; 15-19, 13.2%; 20-24, 20.6%; and ≥25, 50%. (iv) Multivariable analysis showed that emergency surgery, American Society of Anesthesiologist class ≥IV, CTP score ≥7, MELD score ≥10, and MELDNa score ≥10 were independent risk factors for 90-day mortality. (v) The area under the receiver operating curve of CTP, MELD, and MELDNa in predicting 90-day mortality were 0.859, 0.761, 0.818, and nonparametric approach using the generalized U-statistic showed that the CTP score was equal to the MELDNa score (P=0.855) and the CTP and MELDNa scores were superior to the MELD score (P=0.027 and 0.047) in predicting postoperative 90-day mortality.

Conclusion: Mortality according to the CTP, MELD, and MELDNa scoring systems were determined and all scoring systems predicted postoperative mortality in patients with cirrhosis. The CTP score and MELDNa score were superior to the MELD score in predicting postoperative 90-day mortality.