Risk factor analysis in patients with liver cirrhosis undergoing cardiovascular operations.
BACKGROUND
Variable outcomes of cardiac operations have been reported in cirrhotic patients, but no definitive predictive prognostic factors have been established. This retrospective study assessed operative results to identify risk factors associated with morbidity after cardiovascular operations in cirrhotic patients.


METHODS
The study comprised 42 cirrhotic patients who underwent cardiovascular operations from January 1991 to January 2009. Thirty patients were Child-Turcotte-Pugh class A, and 12 were class B. Hospital morbidity occurred in 13 patients (31.0%; M group), including 4 who died in-hospital. Patients without severe complications (N group) were compared with the M group patients. The Model for End-Stage Liver Disease (MELD) score was evaluated in 25 patients.


RESULTS
Significant differences in hospital morbidity between the M vs N groups were identified for platelet count (8.7 +/- 3.8 vs 12.1 +/- 4.2 x 10(4)/microL), MELD score (17.8 +/- 5.3 vs 9.8 +/- 4.9), operation time (370 +/- 88 vs 313 +/- 94 minutes), and cardiopulmonary bypass time (174 +/- 46 vs 149 +/- 53 minutes) in univariate analyses (p < 0.005). Platelet count, operation time, and age were significantly associated with hospital morbidity in multivariate analyses (p < 0.005). Platelet count of 9.6 x 10(4)/microL and MELD score of 13 were cutoff values for hospital morbidity.


CONCLUSIONS
Careful consideration of operative indications and methods are necessary in cirrhotic patients with low platelet counts or high MELD scores. A high incidence of hospital morbidity is predicted in patients with platelet counts of less than 9.6 x 10(4)/microL or MELD scores exceeding 13.
Morisaki
Akimasa
A
Department of Cardiovascular Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan. m2013922@med.osaka-cu.ac.jp
Hosono
Mitsuharu
M
Sasaki
Yasuyuki
Y
Kubo
Shoji
S
Hirai
Hidekazu
H
Suehiro
Shigefumi
S
Shibata
Toshihiko
T
D000368:Aged; D001011:Aorta; D001989:Bronchiolitis Obliterans; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000401:mortality; D002315:Cardiopulmonary Bypass; D001026:Coronary Artery Bypass; D005260:Female; D006351:Heart Valves / Q000601:surgery; D006801:Humans; D008103:Liver Cirrhosis; D008297:Male; D010976:Platelet Count; D011183:Postoperative Complications; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D015996:Survival Rate