title: Model for end-stage liver disease score predicts left ventricular assist device operative transfusion requirements, morbidity, and mortality.
abstract: BACKGROUND
  The Model for End-Stage Liver Disease (MELD) predicts events in cirrhotic subjects undergoing major surgery and may offer similar prognostication in left ventricular assist device candidates with comparable degrees of multisystem dysfunction.
  
  
  RESULTS
  Preoperative MELD scores were calculated for subjects enrolled in the University of Michigan Health System (UMHS) mechanical circulatory support database. Univariate and multiple regression analyses were performed to investigate the ability of patient characteristics, laboratory data (including MELD scores), and hemodynamic measurements to predict total perioperative blood product exposure and operative mortality. The ability of preoperative MELD scores to predict operative mortality was evaluated in subjects enrolled in the Interagency Registry of Mechanically Assisted Circulatory Support (INTERMACS), and results were compared with those from the UMHS cohort. The mean+/-SD MELD scores for the UMHS (n=211) and INTERMACS (n=324) cohorts were 13.7+/-6.1 and 15.2+/-5.8, respectively, with 29 (14%) and 19 (6%) perioperative deaths. In the UMHS cohort, median total perioperative blood product exposure was 74 units (25th and 75th percentiles, 44 and 120 units). Each 5-unit MELD score increase was associated with 15.1+/-3.8 units (beta+/-SE) of total perioperative blood product exposure. Each 10-unit increase in total perioperative blood product exposure increased the odds of operative death (odds ratio, 1.05; 95% confidence interval, 1.01 to 1.10). Odds ratios, measuring the ability of MELD scores to predict perioperative mortality, were 1.5 (95% confidence interval, 1.1 to 2.0) and 1.5 (95% confidence interval, 1.1 to 2.1) per 5 MELD units for the UMHS and INTERMACS cohorts, respectively. When MELD scores were dichotomized as >or=17 and <17, risk-adjusted Cox proportional-hazard ratios for 6-month mortality were 2.5 (95% confidence interval, 1.2 to 5.3) and 2.5 (95% confidence interval, 1.1 to 5.4) for the UMHS and INTERMACS cohorts, respectively.
  
  
  CONCLUSIONS
  The MELD score identified left ventricular assist device candidates at high risk for perioperative bleeding and mortality.
authors.affiliation: Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI 48109-5853, USA. jennmatt@umich.edu
authors.forename: Jennifer C
authors.initials: JC
authors.lastname: Matthews
authors.forename: Francis D
authors.initials: FD
authors.lastname: Pagani
authors.forename: Jonathan W
authors.initials: JW
authors.lastname: Haft
authors.forename: Todd M
authors.initials: TM
authors.lastname: Koelling
authors.forename: David C
authors.initials: DC
authors.lastname: Naftel
authors.forename: Keith D
authors.initials: KD
authors.lastname: Aaronson
mesh_terms: D016063:Blood Loss, Surgical; D001803:Blood Transfusion; D006352:Heart Ventricles / Q000601:surgery*; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D008103:Liver Cirrhosis; D017093:Liver Failure / Q000150:complications* / Q000401:mortality; D009017:Morbidity; D009026:Mortality; D019990:Perioperative Care; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis