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. 2022 Sep;70(9):770-778.
doi: 10.1007/s11748-022-01797-4. Epub 2022 Mar 20.

Helpfulness of the liver disease scores in cardiac surgery for cirrhotic patients

Alexandre Sebestyen  1 , Alaae Boutayeb  2 , Michel Durand  3 , Cécile Martin  3 , Marie-Noëlle Hilleret  4 , Damien Bedague  3 , Delphine Rhem  3 , Olivier Chavanon  2
Affiliations

Helpfulness of the liver disease scores in cardiac surgery for cirrhotic patients

Alexandre Sebestyen et al. Gen Thorac Cardiovasc Surg. 2022 Sep.

Abstract

Objectives: Liver cirrhosis is a well-known risk factor of mortality after cardiac surgery, but not considered in the widely used EuroSCOREII (ESII). The objective was to analyse the performance of the ESII, the Child-Pugh-Turcotte (CPT) and the Model of End-stage Liver Disease (MELD) scores to predict hospital mortality in cardiac surgery for cirrhotic patients and to analyse the survival according to the preoperative cirrhosis status.

Methods: Preoperative and cirrhosis characteristics and postoperative outcomes were compared according to hospital mortality. The performance of the 3 scores was analysed by the area under the receiver-operating characteristics (AUC-ROC) by DeLong's method. The survival of the patients who were discharged was analysed by Kaplan-Meier curves according to the preoperative cirrhosis status.

Results: Seventy-four patients were included. Observed hospital mortality was 12%, the predictive mortality by ESII was 3.9% ± 5.2%, and AUC-ROC was 0.67 [0.44-0.90]. Only the MELD score was discriminant (AUC-ROC 0.75 [0.57-0.93]). The observed hospital mortality increased by threefold over the ESII (12% versus 3.9%, p < 0.001), except the patients with MELD < 10 for whom hospital mortality was similar as ESII (3% versus 2.6%, p = 0.89). Long-term survival was higher for the MELD < 10 patients.

Conclusions: The ESII did not predict hospital mortality after a cardiac surgery in cirrhotic patients and the MELD score should be considered for decision of cardiac intervention in cirrhotic patients.

Keywords: Cardiac surgery; Hospital mortality; Liver cirrhosis; Score; Survival.

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