title: The utility of the MELD score in predicting mortality following liver resection for metastasis.
abstract: BACKGROUND
  The MELD score has been demonstrated to be predictive of hepatectomy outcomes in mixed patient samples of primary and secondary liver cancers. Because MELD is a measure of hepatic dysfunction, prior conclusions may rely on the high prevalence of cirrhosis observed with primary lesions. This study aims to evaluate MELD score as a predictor of mortality and develop a risk prediction model for patients specifically undergoing hepatic metastasectomy.
  
  
  METHODS
  ACS-NSQIP 2005-2013 was analyzed to select patients who had undergone liver resections for metastases. A receiver operating characteristic (ROC) analysis determined the MELD score most associated with 30-day mortality. A literature review identified variables that impact hepatectomy outcomes. Significant factors were included in a multivariable analysis (MVA). A risk calculator was derived from the final multivariable model.
  
  
  RESULTS
  Among the 14,919 patients assessed, the mortality rate was 2.7%, and the median MELD was 7.3 (range = 34.4). A MELD of 7.24 was identified by ROC (sensitivity = 81%, specificity = 51%, c-statistic = 0.71). Of all patients above this threshold, 4.4% died at 30 days vs. 1.1% in the group ≤7.24. This faction represented 50.1% of the population but accounted for 80.3% of all deaths (p < 0.001). The MVA revealed mortality to be increased 2.6-times (OR = 2.55, 95%CI 1.69-3.84, p < 0.001). A risk calculator was successfully developed and validated.
  
  
  CONCLUSIONS
  MELD>7.24 is an important predictor of death following hepatectomy for metastasis and may prompt a detailed assessment with the provided risk calculator. Attention to MELD in the preoperative setting will improve treatment planning and patient education prior to oncologic liver resection.
authors.affiliation: Department of Surgery, Cooper University Hospital, 3 Cooper Plaza, Suite 411, Camden, NJ, 08103, USA. Electronic address: fromer-marc@cooperhealth.edu.
authors.forename: M W
authors.initials: MW
authors.lastname: Fromer
authors.affiliation: Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1400 Herman Pressler, Unit 1484, Houston, TX, 77030, USA. Electronic address: TAAloia@mdanderson.org.
authors.forename: T A
authors.initials: TA
authors.lastname: Aloia
authors.affiliation: Department of Surgery, Cooper University Hospital, 3 Cooper Plaza, Suite 411, Camden, NJ, 08103, USA. Electronic address: gaughan-john@cooperhealth.edu.
authors.forename: J P
authors.initials: JP
authors.lastname: Gaughan
authors.affiliation: Department of Surgery, Cooper University Hospital, 3 Cooper Plaza, Suite 411, Camden, NJ, 08103, USA. Electronic address: atabek-umur@cooperhealth.edu.
authors.forename: U M
authors.initials: UM
authors.lastname: Atabek
authors.affiliation: Department of Surgery, Cooper University Hospital, 3 Cooper Plaza, Suite 411, Camden, NJ, 08103, USA. Electronic address: Spitz-Francis@cooperhealth.edu.
authors.forename: F R
authors.initials: FR
authors.lastname: Spitz
mesh_terms: D000368:Aged; D003404:Creatinine / Q000097:blood; D005260:Female; D006498:Hepatectomy / Q000401:mortality*; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary* / Q000601:surgery*; D008297:Male; D059146:Metastasectomy / Q000401:mortality*; D008875:Middle Aged; D012720:Severity of Illness Index
chemical_list: D003404:Creatinine
keywords: Hepatectomy; Liver resection; MELD score; Metastasis; Model for end-stage liver disease; Mortality complication