title: Predictive risk factors for patients with cirrhosis undergoing heart surgery.
abstract: BACKGROUND
  Empiric experiences suggest higher mortality and complication risk for patients with cirrhosis of the liver after cardiac surgery. However, cirrhosis is not considered a risk factor in either the EuroSCORE or The Society of Thoracic Surgeons score. We report a large single-center experience of patients with cirrhosis undergoing cardiac surgery with extracorporeal circulation and aimed to evaluate the severity of cirrhosis as a predictor of outcome.
  
  
  METHODS
  During 2001 and 2011, we operated on 109 consecutive patients (average age, 64 years; 82 male) diagnosed for cirrhosis with cardiopulmonary bypass for different indications. Thirty-day mortality and long-term mortality were set as primary study end points.
  
  
  RESULTS
  Thirty-day mortality was 26%, and 5-year survival was 19%. Patients categorized as Child-Turcotte-Pugh (CHILD) C (n=6; 67% 30-day survival; 0% 5-year survival) and B (n=30; 60%; 5%) had worse 30-day and 5-year survival compared with patients categorized as CHILD A (n=73; 80%; 25%). For 30-day mortality, preoperative EuroSCORE (p=0.015), model for end-stage liver disease (MELD) score (p=0.006), albumin (p=0.023), total protein (p=0.01), and myocardial infarction (p=0.049) revealed significant differences between survivors and nonsurvivors. Multivariate logistic regression identified only MELD score (odds ratio [OR], 1.12; 95% confidence interval [CI], 1.03 to 1.23; p=0.011) and total protein (OR, 0.97; 95% CI, 0.95 to 1; p=0.049) were connected with increased 30-day mortality. Cox regression analysis revealed EuroSCORE (OR, 1.02; 95% CI, 1.01 to 1.03; p<0.0001) and MELD (OR, 1.06; 95% CI, 1.01 to 1.12; p=0.016) predicting the overall mortality. Receiver operating characteristic analysis indicated significant predictive power of MELD (p=0.001) and EuroSCORE (p=0.027) for 30-day mortality.
  
  
  CONCLUSIONS
  Patients with cirrhosis undergoing heart surgery with extracorporeal circulation have a poor prognosis. Several preoperative factors are related to outcome. EuroSCORE and MELD score may help to evaluate operation risk and indication.
authors.affiliation: Department of Cardiac Surgery, University Hospital Heidelberg, Heidelberg, Germany. rawa.arif@med.uni-heidelberg.de
authors.forename: Rawa
authors.initials: R
authors.lastname: Arif
authors.forename: Philipp
authors.initials: P
authors.lastname: Seppelt
authors.forename: Simon
authors.initials: S
authors.lastname: Schwill
authors.forename: Dubravka
authors.initials: D
authors.lastname: Kojic
authors.forename: Ali
authors.initials: A
authors.lastname: Ghodsizad
authors.forename: Arjang
authors.initials: A
authors.lastname: Ruhparwar
authors.forename: Matthias
authors.initials: M
authors.lastname: Karck
authors.forename: Klaus
authors.initials: K
authors.lastname: Kallenbach
mesh_terms: D001706:Biopsy; D006348:Cardiac Surgical Procedures; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006331:Heart Diseases / Q000150:complications / Q000401:mortality / Q000601:surgery*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000175:diagnosis / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends