title: Mortality after surgery in patients with liver cirrhosis: comparison of Child-Turcotte-Pugh, MELD and MELDNa score.
abstract: OBJECTIVE
  This study was aimed at determining the postoperative mortality in patients with cirrhosis by Child-Turcotte-Pugh (CTP), Model for End-stage Liver Disease score (MELD), and Model for End-stage Liver Disease and Serum Sodium Concentration score (MELDNa) systems and to compare the predictability of the scoring systems.
  
  
  METHODS
  Analysis was performed on clinical records of 490 patients with cirrhosis who underwent surgery under general anesthesia from January 2003 to December 2008.
  
  
  RESULTS
  (i) Ninety-day mortality in patients with CTP A, B, and C class were 2.1, 22.1 and 54.5%, respectively. (ii) Ninety-day mortality according to MELD score was as follows: 6-9, 3.5%; 10-14, 8.9%; 15-19, 14.3%; 20-24, 12.5%; and ≥25, 63.6%. (iii) Ninety-day mortality according to MELDNa score was as follows: 6-9, 1.9%; 10-14, 6.2%; 15-19, 13.2%; 20-24, 20.6%; and ≥25, 50%. (iv) Multivariable analysis showed that emergency surgery, American Society of Anesthesiologist class ≥IV, CTP score ≥7, MELD score ≥10, and MELDNa score ≥10 were independent risk factors for 90-day mortality. (v) The area under the receiver operating curve of CTP, MELD, and MELDNa in predicting 90-day mortality were 0.859, 0.761, 0.818, and nonparametric approach using the generalized U-statistic showed that the CTP score was equal to the MELDNa score (P=0.855) and the CTP and MELDNa scores were superior to the MELD score (P=0.027 and 0.047) in predicting postoperative 90-day mortality.
  
  
  CONCLUSIONS
  Mortality according to the CTP, MELD, and MELDNa scoring systems were determined and all scoring systems predicted postoperative mortality in patients with cirrhosis. The CTP score and MELDNa score were superior to the MELD score in predicting postoperative 90-day mortality.
authors.affiliation: Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Hyun Chin
authors.initials: HC
authors.lastname: Cho
authors.forename: Han Young
authors.initials: HY
authors.lastname: Jung
authors.forename: Dong Hyun
authors.initials: DH
authors.lastname: Sinn
authors.forename: Moon Seok
authors.initials: MS
authors.lastname: Choi
authors.forename: Kwang Cheol
authors.initials: KC
authors.lastname: Koh
authors.forename: Seung Woon
authors.initials: SW
authors.lastname: Paik
authors.forename: Byung Chul
authors.initials: BC
authors.lastname: Yoo
authors.forename: Seon Woo
authors.initials: SW
authors.lastname: Kim
authors.forename: Joon Hyeok
authors.initials: JH
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006509:Hepatitis B / Q000150:complications; D006526:Hepatitis C / Q000150:complications; D006801:Humans; D008103:Liver Cirrhosis / Q000209:etiology / Q000401:mortality* / Q000601:surgery*; D008108:Liver Diseases, Alcoholic / Q000150:complications; D017093:Liver Failure / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012720:Severity of Illness Index; D055815:Young Adult