title: Model for End-Stage Liver Disease (MELD) predicts nontransplant surgical mortality in patients with cirrhosis.
abstract: OBJECTIVE
  We sought to determine the ability of the Model for End-Stage Liver Disease (MELD) score to predict 30-day postoperative mortality for patients with cirrhosis undergoing nontransplant surgical procedures.
  
  
  BACKGROUND
  The Child-Pugh class historically has been used by clinicians to assist in management decisions involving patients with cirrhosis. However, this classification scheme has a number of limitations. Recently, MELD was introduced. It has been shown to be highly predictive of mortality in a variety of clinical scenarios.
  
  
  METHODS
  Adult patients with a diagnosis of cirrhosis undergoing nontransplant surgical procedures between January 1, 1996, and January 1, 2002, at a single center were analyzed. The preoperative MELD score was calculated for all patients, and the MELD's performance in predicting 30-day mortality was determined using multivariate regression techniques.
  
  
  RESULTS
  A total of 140 surgical procedures were identified and analyzed. The 30-day mortality rate was 16.4%. The mean admission MELD score for the patients who died (23.3, 95% confidence interval 19.6-27.0) was significantly different from those patients surviving beyond 30 days (16.9, 15.6-18.2), P = 0.0003. The c-statistic for MELD score predicting 30-day mortality was 0.72. Further subgroup analysis of 67 intra-abdominal surgeries showed an in-hospital mortality of 23.9%. The mean MELD score for patients dying (24.8, 20.4-29.3) was significantly different from survivors (16.2, 14.2-18.2), P = 0.0001. The c-statistic for this subgroup was 0.80.
  
  
  CONCLUSIONS
  The MELD score, as an objective scale of disease severity in patients with cirrhosis, shows promise as being a useful preoperative predictor of surgical mortality risk.
authors.affiliation: Division of Gastroenterology and Hepatology, University of Virginia Health System, Charlottesville, Virginia 22908, USA. pgn5qs@virginia.edu
authors.forename: Patrick G
authors.initials: PG
authors.lastname: Northup
authors.forename: Ryan C
authors.initials: RC
authors.lastname: Wanamaker
authors.forename: Vanessa D
authors.initials: VD
authors.lastname: Lee
authors.forename: Reid B
authors.initials: RB
authors.lastname: Adams
authors.forename: Carl L
authors.initials: CL
authors.lastname: Berg
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000401:mortality* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D012044:Regression Analysis; D012720:Severity of Illness Index