Model for end-stage liver disease score versus Child score in predicting the outcome of surgical procedures in patients with cirrhosis.
OBJECTIVE
To determine factors affecting the outcome of patients with cirrhosis undergoing surgery and to compare the capacities of the Child-Turcotte-Pugh (CTP) and model for end-stage liver disease (MELD) score to predict that outcome.


METHODS
We reviewed the charts of 195 patients with cirrhosis who underwent surgery at two teaching hospitals over a five-year period. The combined endpoint of death or hepatic decompensation was considered to be the primary endpoint.


RESULTS
Patients who reached the endpoint had a higher MELD score, a higher CTP score and were more likely to have undergone an urgent procedure. Among patients undergoing elective surgical procedures, no statistically significant difference was noted in the mean MELD (12.8 +/- 3.9 vs 12.6 +/- 4.7, P = 0.9) or in the mean CTP (7.6 +/- 1.2 vs 7.7 +/- 1.7, P = 0.8) between patients who reached the endpoint and those who did not. Both mean scores were higher in the patients reaching the endpoint in the case of urgent procedures (MELD: 22.4 +/- 8.7 vs 15.2 +/- 6.4, P = 0.0007; CTP: 9.9 +/- 1.8 vs 8.5 +/- 1.8, P = 0.008). The performances of the MELD and CTP scores in predicting the outcome of urgent surgery were only fair, without a significant difference between them (AUC = 0.755 +/- 0.066 for MELD vs AUC = 0.696 +/- 0.070 for CTP, P = 0.3).


CONCLUSIONS
The CTP and MELD scores performed equally, but only fairly in predicting the outcome of urgent surgical procedures. Larger studies are needed to better define the factors capable of predicting the outcome of elective surgical procedures in patients with cirrhosis.
Hoteit
Maarouf-A
MA
Division of Digestive Diseases, Emory University, Atlanta, GA 30322, United States.
Ghazale
Amaar-H
AH
Bain
Andrew-J
AJ
Rosenberg
Eli-S
ES
Easley
Kirk-A
KA
Anania
Frank-A
FA
Rutherford
Robin-E
RE
D000368:Aged; D000768:Anesthesia, General / Q000009:adverse effects* / Q000401:mortality; D017558:Elective Surgical Procedures / Q000009:adverse effects* / Q000401:mortality; D004638:Emergency Treatment / Q000009:adverse effects* / Q000401:mortality; D005260:Female; D005845:Georgia; D006305:Health Status Indicators; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D017093:Liver Failure / Q000209:etiology* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D018579:Patient Selection; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome