Association of Model for End-Stage Liver Disease Score With Mortality in Emergency General Surgery Patients

Havens, Joaquim M.; Columbus, Alexandra B.; Olufajo, Olubode A.; Askari, Reza; Salim, Ali; Christopher, Kenneth B.

doi:10.1001/jamasurg.2016.0789

Cited by 21 publications

(10 citation statements)

References 41 publications

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“…However, because most major complications occurring in cirrhotic patients do require in‐patient admission, we feel that this study is reflective of the general population. We also noted that the admission MELD score for our population is lower than expected compared to other academic medical centres, 36,37 possibly limiting the generalisability of our results. However, this may also reflect the benefits of NSBBs in patients in less advanced stages of cirrhosis.…”

Section: Discussioncontrasting

confidence: 67%

Non‐selective beta‐blocker use in cirrhotic patients is associated with a reduced likelihood of hospitalisation for infection

Sasso

Rockey

2020

Aliment Pharmacol Ther

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SummaryBackgroundNon‐selective beta‐blockers (NSBBs) reduce enteric bacterial translocation rates and the frequency of spontaneous bacterial peritonitis (SBP) in animal models.AimTo evaluate the effect of NSBBs on infection‐related admissions.MethodsWe performed a case‐control study of cirrhotic patients' first in‐patient admission between 1 January 2011 and 31 December 2016. We examined NSBB use and the development of infection. We performed a propensity score‐matched analysis in those with NSBB use vs no use and calculated odds ratios on this matched cohort to determine the odds of outcomes based on NSBB use.ResultsWe identified 2165 cirrhotic patients who met our inclusion criteria. Most patients were Caucasian (69%), male (62%). Admission Model for End stage Liver Disease (MELD) score, Charlson comorbidity index and Child‐Pugh score were 12 ± 1, 4 ± 2, and 8 ± 2, respectively. Ascites was the most common complication of portal hypertension (44%); 23% of patients used NSBBs at home. Infections occurred in 33% of admissions. In the propensity score‐matched cohort, the use of NSBBs at home was associated with lower overall, and specific, infections. The effect was similar in patients taking NSBBs for either primary or secondary oesophageal variceal prophylaxis and for those on NSBBs for other indications. Patients not on NSBBs had higher odds of infection (OR = 2.5), SBP (OR = 4.0), and bacteraemia (OR = 6.0).ConclusionHome use of NSBBs by patients with cirrhosis was associated with fewer infection‐related admissions. The data suggest that NSBBs in this group of patients reduce the risk of infection.

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Section: Discussioncontrasting

confidence: 67%

Non‐selective beta‐blocker use in cirrhotic patients is associated with a reduced likelihood of hospitalisation for infection

Sasso

Rockey

2020

Aliment Pharmacol Ther

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“…In concordance with our findings, Hemida et al [29] showed that the MELD score had high sensitivity (100%) and moderate specificity (64%) for the prediction of death in cirrhotic cases submitted to non-hepatic procedures. Another retrospective study demonstrated that MELD score was associated with 90-day mortality following emergency surgery in patients with cirrhosis [30].…”

Section: Discussionmentioning

confidence: 99%

Portal Venous Pressure as a Predictor of Mortality in Child’s A Cirrhotic Patients Undergoing Elective Surgery: A Prospective Study

El‐ghobary¹,

Salman²,

Shaaban³

et al. 2020

Open Access Maced J Med Sci

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BACKGROUND: Recently, portal venous pressure (PVP) exhibited high sensitivity and specificity in anticipating death in cirrhotic cases submitted to emergency operations. AIM: The current prospective work aimed to evaluate the utility of PVP in predicting 1st month post-operative death in Child’s A cirrhotic cases who underwent elective operations. METHODS: One-hundred and twenty cirrhotic cases that were planned to undergo elective surgery were enrolled in the current prospective work. The intraoperative (I.O) PVP and central venous pressure (CVP) were measured. The statistical analysis was performed using the SPSS version 22.0. The receiver operative curve was plotted to measure the predictive value of PVP. Multivariate analysis was done using logistic regression method for the significant variables impacting mortality on univariate analysis. RESULTS: Twenty-nine patients died in the current work. Patients who survived had statistically considerably lower PVP than patients who died (8.2 ± 1.5 vs. 12.5 ± 1.6 mmHg, respectively, p < 0.001). Similarly, patients who died had significantly higher I.O CVP (p < 0.001), body mass index (p < 0.001), and were more likely to have model for end-stage liver disease score between 9 and 16 (p = 0.003). At a cutoff value ≥10.5 mmHg, the PVP had a sensitivity of 82.8% and specificity of 93.4% for the prediction of mortality. The logistic regression analysis showed that only PVP (odds ratio [OR] =3.1, 95% confidence interval [CI] 1.25–7.5) and CVP (OR = 2.8, 95% CI 1.2–6.5) were the only independent predictors of mortality. CONCLUSION: PVP is a significant predictor of death in Child’s A cirrhotic cases submitted to elective operations.

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“…Previous investigators have used markers such as MELD and Child-Pugh scoring to predict operative outcomes in cirrhotic patients [ 9 - 11 ]. MELD was originally created to predict 30-day mortality after a TIPS procedure in a liver transplant candidate but has become a marker for severity of liver disease and is currently used to prioritize patients on the transplant list [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

Cirrhosis, Operative Trauma, Transfusion, and Mortality: A Multicenter Retrospective Observational Study

Isbell

Cohn

Inaba³

et al. 2018

Cureus

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Background: In trauma patients with cirrhosis who require laparotomy, little data exists to establish clinical predictors of the outcome. We sought to determine the prognosticators of mortality in this population.Methods: We performed a 10-year review at four, busy Level I trauma centers of patients with cirrhosis identified during trauma laparotomy. We compared vital signs, laboratory values, and transfusion requirements for those who survived versus those who died. A linear regression was then conducted to determine the variables associated with death in this population.Results: A total of 66 patients were included and 47% (31/66) died. The model for end-stage liver disease (MELD) score was low (7.8 in Lived, 10.2 in Died). Packed red blood cell (PRBC) transfusion at six hours was greater in those who died; those receiving > 6 units of PRBCs at 6 hours had an increased likelihood of death (odds ratio OR 5.8 (95% CI 1.9, 17.4)). All patients receiving ≥ 17 units of PRBCs died. We found an association between lower preoperative platelets (PLTs), higher preoperative international normalized ratio (INR) and partial thromboplastin time (PTT), lower preoperative pH (presence of profound acidemia), increased intraoperative crystalloid use, and increased intraoperative blood product administration to be associated with death (p < 0.05).Conclusions: Cirrhotic trauma patients requiring laparotomy should be considered to have a high chance of mortality if they receive six or more PRBCs, are acidotic (pH ≤ 7.25) at the time of hospital arrival, or have coagulopathy at the time of admission (INR > 1.2, PTT > 40).

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Association of Model for End-Stage Liver Disease Score With Mortality in Emergency General Surgery Patients

Cited by 21 publications

References 41 publications

Non‐selective beta‐blocker use in cirrhotic patients is associated with a reduced likelihood of hospitalisation for infection

Non‐selective beta‐blocker use in cirrhotic patients is associated with a reduced likelihood of hospitalisation for infection

Portal Venous Pressure as a Predictor of Mortality in Child’s A Cirrhotic Patients Undergoing Elective Surgery: A Prospective Study

Cirrhosis, Operative Trauma, Transfusion, and Mortality: A Multicenter Retrospective Observational Study

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