title: MELD-based indices as predictors of mortality in chronic liver disease patients who undergo emergency surgery with general anesthesia.
abstract: BACKGROUND
  Underlying chronic liver disease is associated with high morbidity and mortality after emergency surgery, which complicates clinical decisions over performing such surgery. In addition, the Child-Turcotte-Pugh (CTP) score is limited in its ability to predict postoperative residual liver function. This study was designed to determine whether the scores of the Model for End-stage Liver Disease (MELD)-based indices are effective predictors of mortality following emergency surgery in patients with chronic liver disease.
  
  
  METHODS
  Medical records of 53 chronic liver disease patients who underwent emergency surgery under general anesthesia from 2001 to 2008 were analyzed retrospectively.
  
  
  RESULTS
  Median preoperative CTP score was 6 (5-12); MELD, 11 (6-33); MELD-Na, 15 (7-34); integrated MELD (iMELD), 33 (14-64); and MELD to sodium ratio, 8 (4-24). During a median 11-month follow-up period, 19 (35.8%) patients died. Five of them (26.3%) had operative mortality (i.e., mortality within 30 days after surgery). On multivariate analysis, CTP class C was correlated with operative mortality, and estimated blood loss above 300 ml and the iMELD score above 35 were significantly correlated with overall mortality.
  
  
  CONCLUSIONS
  iMELD reflects underlying liver function and predicts overall mortality more accurately than CTP and other MELD-based indices scores do in chronic liver disease patients after emergency surgery with general anesthesia.
authors.affiliation: Department of Surgery, Yonsei University College of Medicine, 134, Shinchon-dong, Seodaemun-gu, Seoul, 120-752, South Korea.
authors.forename: Sung Hoon
authors.initials: SH
authors.lastname: Kim
authors.forename: Yoon Dae
authors.initials: YD
authors.lastname: Han
authors.forename: Jae Gil
authors.initials: JG
authors.lastname: Lee
authors.forename: Do Young
authors.initials: DY
authors.lastname: Kim
authors.forename: Sae Byeol
authors.initials: SB
authors.lastname: Choi
authors.forename: Gi Hong
authors.initials: GH
authors.lastname: Choi
authors.forename: Jin Sub
authors.initials: JS
authors.lastname: Choi
authors.forename: Kyung Sik
authors.initials: KS
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000768:Anesthesia, General / Q000009:adverse effects; D019540:Area Under Curve; D016063:Blood Loss, Surgical; D001810:Blood Volume; D002908:Chronic Disease; D004638:Emergency Treatment / Q000401:mortality*; D058625:End Stage Liver Disease / Q000503:physiopathology; D005260:Female; D006801:Humans; D007902:Length of Stay; D008107:Liver Diseases / Q000150:complications / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012372:ROC Curve; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013514:Surgical Procedures, Operative / Q000401:mortality*; D055815:Young Adult