Helpfulness of the liver disease scores in cardiac surgery for cirrhotic patients.
Cardiac surgery
Hospital mortality
Liver cirrhosis
Score
Survival
Journal
General thoracic and cardiovascular surgery
ISSN: 1863-6713
Titre abrégé: Gen Thorac Cardiovasc Surg
Pays: Japan
ID NLM: 101303952
Informations de publication
Date de publication:
Sep 2022
Sep 2022
Historique:
received:
19
11
2021
accepted:
25
02
2022
pubmed:
21
3
2022
medline:
16
8
2022
entrez:
20
3
2022
Statut:
ppublish
Résumé
Liver cirrhosis is a well-known risk factor of mortality after cardiac surgery, but not considered in the widely used EuroSCOREII (ESII). The objective was to analyse the performance of the ESII, the Child-Pugh-Turcotte (CPT) and the Model of End-stage Liver Disease (MELD) scores to predict hospital mortality in cardiac surgery for cirrhotic patients and to analyse the survival according to the preoperative cirrhosis status. Preoperative and cirrhosis characteristics and postoperative outcomes were compared according to hospital mortality. The performance of the 3 scores was analysed by the area under the receiver-operating characteristics (AUC-ROC) by DeLong's method. The survival of the patients who were discharged was analysed by Kaplan-Meier curves according to the preoperative cirrhosis status. Seventy-four patients were included. Observed hospital mortality was 12%, the predictive mortality by ESII was 3.9% ± 5.2%, and AUC-ROC was 0.67 [0.44-0.90]. Only the MELD score was discriminant (AUC-ROC 0.75 [0.57-0.93]). The observed hospital mortality increased by threefold over the ESII (12% versus 3.9%, p < 0.001), except the patients with MELD < 10 for whom hospital mortality was similar as ESII (3% versus 2.6%, p = 0.89). Long-term survival was higher for the MELD < 10 patients. The ESII did not predict hospital mortality after a cardiac surgery in cirrhotic patients and the MELD score should be considered for decision of cardiac intervention in cirrhotic patients.
Identifiants
pubmed: 35306624
doi: 10.1007/s11748-022-01797-4
pii: 10.1007/s11748-022-01797-4
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
770-778Informations de copyright
© 2022. The Author(s), under exclusive licence to The Japanese Association for Thoracic Surgery.
Références
Dimarakis I, Grant S, Corless R, Velissaris T, Prince M, Bridgewater B, et al. Impact of hepatic cirrhosis on outcome in adult cardiac surgery. Thorac Cardiovasc Surg. 2015;63:58–66.
pubmed: 25291160
Garatti A, Daprati A, Cottini M, Russo CF, Tomba MD, Troise G, et al. Cardiac Surgery In Patients With Liver Cirrhosis (CASTER) study: early and long-term outcomes. Ann Thorac Surg. 2020;111(4):1242–51.
doi: 10.1016/j.athoracsur.2020.06.110
Schuppan D, Afdhal NH. Liver cirrhosis. Lancet. 2008;371:838–51.
doi: 10.1016/S0140-6736(08)60383-9
Omar RZ, Ambler G, Royston P, Eliahoo J, Taylor KM. Cardiac surgery risk modeling for mortality: a review of current practice and suggestions for improvement. Ann Thorac Surg. 2004;77:2232–7.
doi: 10.1016/j.athoracsur.2003.10.032
Nashef SAM, Roques F, Sharples LD, Nilsson J, Smith C, Goldstone AR, Ulf LU. EuroSCORE II. Eur J Cardiothorac Surg. 2012;41:734–45.
doi: 10.1093/ejcts/ezs043
Barili F, Pacini D, Capo A, Rasovic O, Grossi C, Alamanni F, et al. Does EuroSCORE II perform better than its original versions? A multicentre validation study. Eur Heart J. 2013;34:22–9.
doi: 10.1093/eurheartj/ehs342
Shih T, Paone G, Theurer PF, McDonald D, Shahian DM, Prager RL. The society of thoracic surgeons adult cardiac surgery database version 2.73: more is better. Ann Thorac Surg. 2015;100:516–21.
doi: 10.1016/j.athoracsur.2015.02.085
Chou H-W, Lin M-H, Chen Y-S, Yu H-Y. Impact of MELD score and cardiopulmonary bypass duration on post-operative hypoxic hepatitis in patients with liver cirrhosis undergoing open heart surgery. J Formos Med Assoc Taiwan Yi Zhi. 2020;119:838–44.
doi: 10.1016/j.jfma.2019.08.028
Jacob KA, Hjortnaes J, Kranenburg G, de Heer F, Kluin J. Mortality after cardiac surgery in patients with liver cirrhosis classified by the Child–Pugh score. Interact Cardiovasc Thorac Surg. 2015;20:520–30.
doi: 10.1093/icvts/ivu438
Kamath PS, Kim WR. Advanced liver disease study group the model for end-stage liver disease (MELD). Hepatology. 2007;45:797–805.
doi: 10.1002/hep.21563
Takkenberg JJM, Kappetein AP, Steyerberg EW. Editorial Comment: The role of EuroSCORE II in 21st century cardiac surgery practice. Eur J Cardiothorac Surg. 2013;43:32–3.
doi: 10.1093/ejcts/ezs271
Vanhuyse F, Maureira P, Portocarrero E, Laurent N, Lekehal M, Carteaux J-P, et al. Cardiac surgery in cirrhotic patients: results and evaluation of risk factors. Eur J Cardio-Thorac Surg Off J Eur Assoc Cardio-Thorac Surg. 2012;42:293–9.
doi: 10.1093/ejcts/ezr320
Child CG, Turcotte JG. Surgery and portal hypertension. Major Probl Clin Surg. 1964;1:1–85.
pubmed: 4950264
Suman A, Barnes DS, Zein NN, Levinthal GN, Connor JT, Carey WD. Predicting outcome after cardiac surgery in patients with cirrhosis: a comparison of Child–Pugh and MELD scores. Clin Gastroenterol Hepatol Off Clin Pract J Am Gastroenterol Assoc. 2004;2:719–23.
Filsoufi F, Salzberg SP, Rahmanian PB, Schiano TD, Elsiesy H, Squire A, et al. Early and late outcome of cardiac surgery in patients with liver cirrhosis. Liver Transplant Off Publ Am Assoc Study Liver Dis Int Liver Transplant Soc. 2007;13:990–5.
Thielmann M, Mechmet A, Neuhäuser M, Wendt D, Tossios P, Canbay A, et al. Risk prediction and outcomes in patients with liver cirrhosis undergoing open-heart surgery. Eur J Cardio-Thorac Surg Off J Eur Assoc Cardio-Thorac Surg. 2010;38:592–9.
doi: 10.1016/j.ejcts.2010.02.042
Habibzadeh F, Habibzadeh P, Yadollahie M. On determining the most appropriate test cut-off value: the case of tests with continuous results. Biochem Medica. 2016;26:297–307.
doi: 10.11613/BM.2016.034
Chou A-H, Chen T-H, Chen C-Y, Chen S-W, Lee C-W, Liao C-H, et al. Long-term outcome of cardiac surgery in 1,040 liver cirrhosis patient—nationwide population-based cohort study—. Circ J. 2017;81:476–84.
doi: 10.1253/circj.CJ-16-0849
Chen Y, Liu YX, Seto WK, Wu MZ, Yu YJ, Lam YM, et al. Prognostic value of hepatorenal function by modified model for end-stage liver disease (MELD) score in patients undergoing tricuspid annuloplasty. J Am Heart Assoc. 2018;7:e009020.
doi: 10.1161/JAHA.118.009020
Lin C-H, Hsu R-B. Cardiac surgery in patients with liver cirrhosis: risk factors for predicting mortality. World J Gastroenterol WJG. 2014;20:12608–14.
doi: 10.3748/wjg.v20.i35.12608
Sharma P, Ananthanarayanan C, Vaidhya N, Malhotra A, Shah K, Sharma R. Hyperbilirubinemia after cardiac surgery: an observational study. Asian Cardiovasc Thorac Ann. 2015;23:1039–43.
doi: 10.1177/0218492315607149