Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Oct 2:28:349-357.
doi: 10.1016/j.xjon.2025.09.034. eCollection 2025 Dec.

Association of mild-to-moderate Model for End-Stage Liver Disease scores on short-term cardiac surgery postoperative outcomes

Tom Liu  1 , Zhanlin Chen  2 , Ryan C Jacobs  1 , Charles D Logan  1 , Beth Whippo  1 , Seokyung An  1 , Patrick M McCarthy  1 , Christopher K Mehta  1
Affiliations

Association of mild-to-moderate Model for End-Stage Liver Disease scores on short-term cardiac surgery postoperative outcomes

Tom Liu et al. JTCVS Open. .

Abstract

Objective: We assessed the Model for End-Stage Liver Disease score in patients with mild-moderate scores to predict perioperative outcomes in patients undergoing cardiac surgery.

Methods: The American College Surgeons National Surgical Quality Improvement Program was used to identify patients (2013-2022) undergoing elective isolated coronary artery bypass grafting, aortic valve surgery, or mitral valve surgery. Patients were stratified by low (<9), moderate (9-15), and high (>15) Model for End-Stage Liver Disease scores. Multivariable logistic regression and observed-to-expected ratios were used to assess Model for End-Stage Liver Disease group association and 30-day outcomes.

Results: Of 25,845 patients, 17,743 underwent coronary artery bypass grafting, 5095 underwent aortic valve surgery, and 3007 underwent mitral valve surgery. Increasing Model for End-Stage Liver Disease score (low: n = 18,379; moderate: n = 5922; high: n = 1444) was associated with an increase in mortality for each Model for End-Stage Liver Disease point. The 30-day mortality (low [1.7%], moderate [3.8%], high [8.7%]) and major morbidity (low [25.1%], moderate [33.3%], high [45.7%]) increased with Model for End-Stage Liver Disease severity. Increasing Model for End-Stage Liver Disease category was an independent predictor of 30-day mortality (odds ratio, 1.76; 95% CI, 1.57-1.98) and morbidity (odds ratio, 1.07; 95% CI, 1.02-1.12). The 30-day mortality observed-to-expected ratio was lower in patients with low Model for End-Stage Liver Disease score (observed-to-expected ratio, 0.88; 95% CI, 0.79-0.97) and higher in patients with high Model for End-Stage Liver Disease score (observed-to-expected ratio, 1.15 95% CI, 1.01-1.29). Major morbidity was greater than predicted in all Model for End-Stage Liver Disease categories (all P < .05), driven by increased rates of respiratory complications, renal failure, thromboembolism, and sepsis.

Conclusions: Patients with moderate and low Model for End-Stage Liver Disease scores have adequate outcomes with respect to 30-day mortality. However, surgical risk for patients with high Model for End-Stage Liver Disease scores was underpredicted by traditional risk stratification. Patients with mild to moderate liver disease can undergo cardiac surgery with acceptable surgical mortality.

Keywords: cirrhosis; database; outcomes research; perioperative care.

PubMed Disclaimer

Conflict of interest statement

P.M.M.: Edwards Lifesciences: speaking fees and royalties; AtriCure: speaking fees; Arthrex: advisory board; Genesee: royalties; Abbott: surgical primary investigator REPAIR-MR Trial (unpaid); advisory board. C.K.M.: WL Gore: consulting/speaker, research grant; Baxter: consulting/speaking. All other authors reported no conflicts of interest. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest.

Figures

None
Patients with low-to-moderate MELD scores have acceptable cardiac surgery outcomes.
Figure 1
Figure 1
Cohort diagram. MELD, Model for End Stage Liver Disease.
Figure 2
Figure 2
O:E ratios, by MELD score category. O:E, Observed-to-expected; MELD, Model for End Stage Liver Disease.
Figure 3
Figure 3
Addition of MELD and MELD-Na to NSQIP predictive mortality. MELD, Model for End Stage Liver Disease; NSQIP, National Surgical Quality Improvement Program; ROC, receiver operating characteristic; AUC, area under the curve.
Figure E1
Figure E1
Increase in operative mortality by MELD score.
Figure E2
Figure E2
Increase in major morbidity by MELD score.
See this image and copyright information in PMC

References

    1. An Y., Xiao Y.B., Zhong Q.J. Open-heart surgery in patients with liver cirrhosis: indications, risk factors, and clinical outcomes. Eur Surg Res. 2007;39(2):67–74. - PubMed
    1. Lopez-Delgado J.C., Esteve F., Javierre C., et al. Short-term independent mortality risk factors in patients with cirrhosis undergoing cardiac surgery. Interact Cardiovasc Thorac Surg. 2013;16(3):332–338. - PMC - PubMed
    1. Kaltenbach M.G., Mahmud N. Assessing the risk of surgery in patients with cirrhosis. Hepatol Commun. 2023;7(4) - PMC - PubMed
    1. Hawkins R.B., Young B.A.C., Mehaffey J.H., et al. Model for end-stage liver disease score independently predicts mortality in cardiac surgery. Ann Thorac Surg. 2019;107(6):1713–1719. - PMC - PubMed
    1. Lin C.H., Lin F.Y., Wang S.S., Yu H.Y., Hsu R.B. Cardiac surgery in patients with liver cirrhosis. Ann Thorac Surg. 2014;20(35):12608–12614. - PMC - PubMed

LinkOut - more resources