title: Preoperative hepatic dysfunction could predict postoperative mortality and morbidity in patients undergoing cardiac surgery: Utilization of the MELD scoring system.
abstract: BACKGROUND
  According to recent advances in operative techniques, an increasing number of patients with liver dysfunction have been subjected to cardiac surgery. Model of End-Stage Liver Disease (MELD and MELD-XI) scores allow risk stratification of patients undergoing cardiac and non-cardiac surgeries.
  
  
  METHODS
  We retrospectively analyzed 1856 consecutive patients (69.3% male, mean 66.8 ± 12.2 years) undergoing cardiac surgery between 2008 and 2013 at our institution.
  
  
  RESULTS
  The mean values of MELD/MELD-XI scores obtained from the total cohort were 9.7 ± 4.6/11.9 ± 4.8. Patients with high MELD/MELD-XI scores (>12) were older, more anemic, and had lower left ventricular ejection fraction than those with low scores (all p<0.0001). High scores were associated with longer hospitalization (36.8 ± 33.0 vs. 23.6 ± 21.5 days for MELD, 36.7 ± 34.0 vs. 23.5 ± 21.0 days for MELD-XI, both p<0.0001) and higher in-hospital all-cause mortality (6.6% vs. 1.0% for MELD, 7.7% vs. 0.7% for MELD-XI). Atrial fibrillation occurred more frequently in the high MELD group, but this difference was not found for MELD-XI. MELD/MELD-XI could predict mortality with a sensitivity of 64.3%/60.0% and specificity of 79.1%/85.3%. Comparison of AUC values among MELD scores, individual MELD components, and Child-Turcotte-Pugh (CTP) classification showed that the predictive strength of MELD scores for mortality was stronger than individual parameters or CTP classification (AUC: 0.7702 for MELD, 0.7655 for MELD-XI, 0.5799 for CTP classification with pairwise p<0.0001 and p=0.0002 vs. MELD and MELD-XI, respectively).
  
  
  CONCLUSIONS
  Assessment of liver dysfunction using the MELD scores can be useful for predicting postoperative morbidity and mortality, which may allow additional risk stratification in patients undergoing cardiac surgery.
authors.affiliation: Department of Cardiovascular Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
authors.forename: Mai
authors.initials: M
authors.lastname: Murata
authors.affiliation: Department of Cardiovascular Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan. Electronic address: tokato@juntendo.ac.jp.
authors.forename: Tomoko S
authors.initials: TS
authors.lastname: Kato
authors.affiliation: Department of Cardiovascular Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Kuwaki
authors.affiliation: Department of Cardiovascular Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
authors.forename: Taira
authors.initials: T
authors.lastname: Yamamoto
authors.affiliation: Department of Cardiovascular Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
authors.forename: Shizuyuki
authors.initials: S
authors.lastname: Dohi
authors.affiliation: Department of Cardiovascular Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Amano
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures / Q000401:mortality*; D058625:End Stage Liver Disease / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000150:complications / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D009017:Morbidity / Q000639:trends; D011184:Postoperative Period; D057234:Preoperative Period; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment / Q000706:statistics & numerical data*; D012720:Severity of Illness Index; D015996:Survival Rate / Q000639:trends
keywords: Cardiac surgery; Liver dysfunction; Prognosis; Risk assessment