title: Serum markers for predicting abdominal surgery outcomes in patients with cirrhosis.
abstract: BACKGROUND
  Determinants of adverse events for cirrhotic patients undergoing abdominal surgery have not been adequately assessed. Child-Turcotte-Pugh (CTP) and Model for End-Stage Liver Disease (MELD) have estimated perioperative outcomes with inconsistent results. Our study sought to combine novel serum markers with CTP and MELD to improve prognostication of 30-day postoperative mortality or liver transplant in cirrhotic patients undergoing abdominal surgery.
  
  
  METHODS
  A review was performed on 120 cirrhotic patients undergoing nonhepatic abdominal surgeries at Mount Sinai Medical Center from 2001-2011. Preoperative serum markers were evaluated by logistic regression and receiver-operator characteristics. Prognostic ability of scoring systems was assessed using Youden's J statistic (J).
  
  
  RESULTS
  Albumin and hematocrit were independently predictive of 30-day mortality or transplant with optimal cutoff values of albumin at <3.05 mg/dl and hematocrit at <35.55 %. Adding these criteria to CTP>A, CTP>B, MELD ≥ 10, MELD ≥ 15, and MELD ≥ 20 improved sensitivity and specificity by an average of 6.1 and 32.1 %, respectively. The highest J values resulted from combining novel criteria with CTP>A (sensitivity, 80 %; specificity, 82 %; p < 0.01; J, 0.63) and MELD ≥ 10 (sensitivity, 63 %; specificity, 90 %; p < 0.01; J, 0.53).
  
  
  CONCLUSIONS
  Augmenting CTP and MELD with albumin and hematocrit significantly improved the identification of cirrhotic patients at risk of 30-day mortality or transplantation following nonhepatic abdominal surgery.
authors: Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
authors: Andrew N
authors: AN
authors: Harrington
authors: Edward W
authors: EW
authors: Chu
authors: Malika
authors: M
authors: Garg
authors: Celia M
authors: CM
authors: Divino
mesh_terms: D000005:Abdomen / Q000601:surgery; D015415:Biomarkers / Q000097:blood; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood* / Q000601:surgery*; D016031:Liver Transplantation / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies
chemical_list: D015415:Biomarkers
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