title: Value of MELD and MELD-based indices in surgical risk evaluation of cirrhotic patients: retrospective analysis of 190 cases.
abstract: BACKGROUND
  Recent studies have suggested that the Model for End-Stage Liver Disease (MELD) may represent a promising alternative to the Child-Turcotte-Pugh classification as a predictive factor of operative mortality and morbidity. This study was designed to evaluate the value of MELD and four MELD-based indices (iMELD: integrated MELD; MESO: MELD to sodium ratio; MELD-Na: MELD with incorporation of sodium; MELD-XI: MELD excluding the International Normalized Ratio) in the quantification of surgical risk for patients with cirrhosis and compare its prognostic value with the Child-Turcotte-Pugh classification and two derived scores (proposed by Huo and Giannini, respectively).
  
  
  METHODS
  A retrospective study of 190 patients with cirrhosis, operated on in our department between 1993 and 2008, was undertaken.
  
  
  RESULTS
  Forty-three percent of patients were included in Child-Turcotte-Pugh A class, and their mean MELD score was 12.2 +/- 4.9 (range, 6.4-35.2). Mortality and morbidity rates were 13% and 24%, respectively. In global analysis of mortality, MELD-based indices presented an acceptable prognostic performance (auROC = 71-77%), similar to the three analyzed Child-Turcotte-Pugh-derived scores. iMELD demonstrated the highest prognostic capacity (auROC = 77%; 95% confidence interval (CI), 66-88; p = 0.0001); operative death probability was 4% (95% CI, 3.6-4.4) when the score was inferior to 35, 16.1% (95% CI, 14.4-17.9) between 35 and 45, and 50.1% (95% CI, 42.2-58.1) when superior to 45. In elective surgical procedures, iMELD represented a useful prognostic factor of operative mortality (auROC = 80%; 95% CI, 63-97; p = 0.044) with significant correlation and better accuracy then MELD and Child-Turcotte-Pugh-derived indices.
  
  
  CONCLUSIONS
  In this study, iMELD was a useful predictive parameter of operative mortality for patients with cirrhosis submitted to elective procedures. Further studies are necessary to define the relevance of MELD-based indices in the individual surgical risk evaluation.
authors.affiliation: IIIrd Surgical Department, Coimbra University Medical School and Hospitals, Praceta Prof. Mota Pinto, 3000-075, Coimbra, Portugal. beatrizpcosta@huc.min-saude.pt
authors.forename: Beatriz P
authors.initials: BP
authors.lastname: Costa
authors.forename: F Castro
authors.initials: FC
authors.lastname: Sousa
authors.forename: Marco
authors.initials: M
authors.lastname: Serôdio
authors.forename: César
authors.initials: C
authors.lastname: Carvalho
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D015897:Comorbidity; D005260:Female; D005762:Gastroenterology / Q000379:methods; D006801:Humans; D008103:Liver Cirrhosis / Q000145:classification* / Q000150:complications / Q000401:mortality; D017093:Liver Failure / Q000145:classification* / Q000150:complications / Q000401:mortality; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012720:Severity of Illness Index; D013514:Surgical Procedures, Operative; D016019:Survival Analysis