title: Mortality after cardiac surgery in patients with liver cirrhosis classified by the Child-Pugh score.
abstract: Liver cirrhosis is a known risk factor for postoperative mortality in patients undergoing cardiac surgery. Clinical assessment of liver cirrhosis using the widely accepted Child-Pugh (CP) score is thus vital for evaluation of surgical options and perioperative care. However, detailed mortality rates as a consequence of liver cirrhosis are unclear. This review aimed to stratify the risk of short-term (<30 days) and overall (up to 10 years) mortality after cardiac surgery in patients with liver cirrhosis, classified by the CP score. Thus, PubMed, Embase, CINAHL and the Cochrane Library were systematically reviewed by two independent investigators for studies published up to February 2014, in which mortality in cirrhotic patients, classified by the CP classification, undergoing cardiac surgery was evaluated postoperatively. A total of 993 articles were identified. After critical appraisal of 21 articles, 19 were selected for final analysis. Weighted short-term mortality of cirrhotic patients undergoing cardiac surgery was 19.3% [95% confidence interval (CI): 16.4-22.5%]. Across the different CP groups, short-term mortality appeared to be 9.0% (95% CI: 6.6-12.2%), 37.7% (95% CI: 30.8-44.3%) and 52.0% (95% CI: 33.5-70.0%) in Groups A, B and C, respectively. Weighted overall mortality within 1 year was 42.0% (95% CI: 36.0-48.3%) in all cirrhotic patients. Subdivided in groups, overall mortality within that 1 year was 27.2% (95% CI: 20.9-34.7%), 66.2% (95% CI: 54.3-76.3%) and 78.9% (95% CI: 56.1-92.1%) in Groups A, B and C, respectively. In conclusion, short-term mortality is considerably increased in patients with liver cirrhosis CP class B and C. Overall mortality is significantly high in all classes of liver cirrhosis.
authors.affiliation: Department of Cardiothoracic Surgery, University Medical Centre Utrecht, Utrecht, Netherlands k.a.jacob@umcutrecht.nl.
authors.forename: Kirolos A
authors.initials: KA
authors.lastname: Jacob
authors.affiliation: Department of Cardiothoracic Surgery, University Medical Centre Utrecht, Utrecht, Netherlands.
authors.forename: Jesper
authors.initials: J
authors.lastname: Hjortnaes
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, Netherlands.
authors.forename: Guido
authors.initials: G
authors.lastname: Kranenburg
authors.affiliation: Department of Cardiothoracic Surgery, University Medical Centre Utrecht, Utrecht, Netherlands.
authors.forename: Frederiek
authors.initials: F
authors.lastname: de Heer
authors.affiliation: Department of Cardiothoracic Surgery, University Medical Centre Utrecht, Utrecht, Netherlands.
authors.forename: Jolanda
authors.initials: J
authors.lastname: Kluin
mesh_terms: D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000175:diagnosis / Q000401:mortality*; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
keywords: Cardiac surgery; Child-Pugh score; Liver cirrhosis; Mortality