title: Postoperative Meld-Lactate and Isolated Lactate Values As Outcome Predictors Following Orthotopic Liver Transplantation.
abstract: The Model for End Stage Liver (MELD) score is validated to predict pretransplant mortality. However, as a predictor of postoperative outcomes, its utility has proven inconsistent. Recently developed MELD-Lactate models better predict 30-day survival as compared with the MELD and MELD-Sodium scores. We compared the MELD-Lactate, original MELD, and MELD-Sodium formulae and the initial postoperative lactate as predictors of 30-day and in-hospital mortality following liver transplantation.Adult patients (n = 989) undergoing orthotopic liver transplant between 2002 to 2013 were included. In addition to the previous models, the first postoperative lactate value and a newly derived Mount Sinai MELD-Lactate score and associated c-statistics were compared.The Mount Sinai MELD-Lactate model yielded the highest c-statistic value (0.749), followed by the original MELD-Lactate (0.740), initial lactate value (0.729), postoperative MELD (0.653), and MELD-Sodium (0.641) models in predicting survival at 30 days following liver transplantation. For in-hospital mortality, the original MELD-Lactate model had slightly higher c-statistic (0.739) compared with the Mount Sinai MELD-Lactate model (0.734). Despite the distribution differences in the MELD-Lactate models, the model validation results, both from cross-validation and bootstrap methods, were similar.Postoperative MELD-Lactate and isolated postoperative lactate values were moderately predictive of 30-day and in-hospital mortality following liver transplantation in this patient cohort.
authors.affiliation: *Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, New York, New York †Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, New York ‡Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York §Anesthesiology Institute, Cleveland Clinic Florida, Weston, Florida.
authors.forename: Sang
authors.initials: S
authors.lastname: Kim
authors.forename: Jeron
authors.initials: J
authors.lastname: Zerillo
authors.forename: Parissa
authors.initials: P
authors.lastname: Tabrizian
authors.forename: David
authors.initials: D
authors.lastname: Wax
authors.forename: Hung-Mo
authors.initials: HM
authors.lastname: Lin
authors.forename: Adam
authors.initials: A
authors.lastname: Evans
authors.forename: Sander
authors.initials: S
authors.lastname: Florman
authors.forename: Samuel
authors.initials: S
authors.lastname: DeMaria
mesh_terms: D016638:Critical Illness; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D019344:Lactic Acid / Q000097:blood*; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D019344:Lactic Acid