Meld Score: A Reliable Predictor of Mortality and Post Operative Complications in Patients with Chronic Liver Disease Undergoing Non-Transplant Surgeries

Abstract

Context: Patients with liver disease are always at high risk of post-operative complications. The prediction of postoperative outcome is very crucial in the management of these patients. Various prediction models are in use to serve this purpose. Childs-Turcotte-Pugh (CTP) and Model of End-Stage Liver Disease (MELD) scoring systems are globally used to predict post-operative mortality in end stage liver disease patients.
 Aims: To compare the results of CTP and MELD scoring systems for predicting outcome in patients of chronic liver disease and to conclude which model is better for risk stratification, so as to enable us in better management of these patients.
 Settings and Design: Observational study
 Methods and Material: This is an Observational study that was carried out at General Surgery Department of Nishtar Medical University and Hospital from October 2019 to March 2020. We collected data from 30 patients. All the surgeries were done by the same team of consultant surgeons. All the investigations were done by the same institution. Scores of both CTP and MELD models were calculated preoperatively and post-operative outcome was compared with them to find out which model was a better predictor of mortality.
 Statistical analysis used: All the continuous variables were reported as mean ± standard deviation. Kaplan Meyer Survival Analysis was conducted to compare post-op survival time among patients divided on the basis of MELD score and CTP Grade. Pooled log rank test was conducted to determine if there were differences in the survival distributions for the different categories in each group. Significant results were followed-up by pair-wise log rank test, at Bonferroni adjusted α level of p <0.0167.
 Results: In our study the mean survival time of 71.20, 54.93, 8.40 for MELD scores of 11-20, 21-30 and >30 has a P value of <0.001. The mean survival time of 56, 54.85, 42.40 for CTP grades of A, B, and C respectively has a P value of 0.582. It shows that according to our study the MELD score has performed better in predicting the post-operative outcome of patients with liver diseases than CTP score.
 Conclusions: Although CTP and MELD both are widely used to predict the post-operative mortality but in our study MELD score has predicted the outcome more effectively than CTP scoring system.