title: Simplified model for end-stage liver disease score predicts mortality for tricuspid valve surgery.
abstract: OBJECTIVE
  The model for end-stage liver disease score (MELD = 3.8*LN[total bilirubin] + 9.6*LN[creatinine] + 11.2*[PT-INR] + 6.4) predicts mortality for tricuspid valve surgery. However, the MELD is problematic in patients undergoing warfarin therapy, as warfarin affects the international normalized ratio (INR). This study aimed to determine whether a simplified MELD score that does not require the INR for calculation could predict mortality for patients undergoing tricuspid valve surgery. Simplified MELD score = 3.8*LN[total bilirubin] + 9.6*LN[creatinine] + 6.4.
  
  
  METHODS
  A total of 172 patients (male: 66, female: 106; mean age, 63.8 ± 10.3 years) who underwent tricuspid replacement (n = 18) or repair (n = 154) from January 1991 to July 2011 at a single centre were included. Of them, 168 patients in whom the simplified MELD score could be calculated were retrospectively analysed. The relationship between in-hospital mortality and perioperative variables was assessed by univariate and multivariate analysis.
  
  
  RESULTS
  The rate of in-hospital mortality was 6.4%. The mean admission simplified MELD score for the patients who died was significantly higher than for those surviving beyond discharge (11.3 ± 4.1 vs 5.8 ± 4.0; P = 0.001). By multivariate analysis, independent risk factors for in-hospital mortality included higher simplified MELD score (P = 0.001) and tricuspid valve replacement (P = 0.023). In-hospital mortality and morbidity increased along with increasing simplified MELD score. Scores <0, 0-6.9, 7-13.9 and >14 were associated with mortalities of 0, 2.0, 8.3 and 66.7%, respectively. The incidence of serious complications (multiple organ failure, P = 0.005; prolonged ventilation, P = 0.01; need for haemodialysis; P = 0.002) was also significantly higher in patients with simplified MELD score ≥ 7.
  
  
  CONCLUSIONS
  The simplified MELD score predicts mortality in patients undergoing tricuspid valve surgery. This model requires only total bilirubin and creatinine and is therefore applicable in patients undergoing warfarin therapy.
authors: Department of Cardiovascular Surgery, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan. umasa715@yahoo.co.jp
authors: Kazumasa
authors: K
authors: Tsuda
authors: Masaaki
authors: M
authors: Koide
authors: Yoshifumi
authors: Y
authors: Kunii
authors: Kazumasa
authors: K
authors: Watanabe
authors: Satoshi
authors: S
authors: Miyairi
authors: Yuko
authors: Y
authors: Ohashi
authors: Takashi
authors: T
authors: Harada
mesh_terms: D000368:Aged; D001663:Bilirubin / Q000097:blood; D015415:Biomarkers / Q000097:blood; D001777:Blood Coagulation / Q000187:drug effects; D015897:Comorbidity; D003404:Creatinine / Q000097:blood; D005260:Female; D006349:Heart Valve Diseases / Q000097:blood / Q000401:mortality / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D019934:International Normalized Ratio; D007564:Japan; D008107:Liver Diseases / Q000097:blood / Q000175:diagnosis* / Q000401:mortality; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000601:surgery*; D014859:Warfarin / Q000627:therapeutic use
chemical_list: D015415:Biomarkers; D014859:Warfarin; D003404:Creatinine; D001663:Bilirubin
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