Session Title: Category 2b. CIRRHOSIS AND ITS COMPLICATIONS: b. CLINICAL ASPECTS
Presentation Date: Apr 15, 2010
MORTALITY AFTER SURGERY IN PATIENTS WITH LIVER CIRRHOSIS : COMPARISON BETWEEN CTP, MELD AND MELDNA SCORE
H.C. Cho1*, D.H. Sinn1, H.Y. Jung1, M.S. Choi1, K.C. Koh1, S.W. Paik1, B.C. Yoo1, S.W. Kim2, J.H. Lee1
1Division of Gastroenterology, Sungkyunkwan University School of Medicine, Samsung Medical Center, 2Biostatics Team, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea. *firstname.lastname@example.org
Background and aims: The aims of this study were to determine the postoperative mortality in patients with cirrhosis by CTP, MELD and MELDNa systems and to compare the predictability of the scoring systems.
Methods: Clinical records of 491 patients with cirrhosis (median age 60, female:male=172:319) who underwent non-hepatic surgery under general anesthesia from January 1, 2003 to December 31, 2008 were analyzed.
1) Thirty-day mortality in patients with CTP A, B and C class cirrhosis was 1.0%, 9.5% and 36.4%.
2) Thirty-day mortality according to MELD score was as follows: 0-4, 0.6%, 5-9, 2.9%, 10-14, 2.8%, 15-19, 4.2%, 20-24, 30%, ≥25, 23.5%.
3) Thirty-day mortality according to MELDNa score was as follows: 0-4, 0.6%, 5-9, 2.5%, 10-14, 3.7%, 15-19, 3.3%, 20-24, 10.5%, ≥25, 28.6%.
4) Multivariate analysis showed that emergency surgery, CTP score ≥7, MELD score≥10, and MELDNa score≥11 were independent risk factors of 30-day mortality.
5) The area under curve (AUC) for CTP, MELDNa, and MELD in predicting 30-day mortality were 0.866, 0.814, 0.732, and pairwise test with a critical ratio z showed no statistically significant difference among three scoring systems (CTP and MELD, adjusted p=0.053: MELD and MELDNa, adjusted p=0.151: CTP and MELDNa, adjusted p=0.661).
6) The AUC for CTP, MELDNa, and MELD in predicting 90-day mortality were 0.859, 0.811, 0.730, and pairwise test with a critical ratio z showed that CTP score was superior to MELD score (adjusted p=0.008) and MELDNa score was superior to MELD score (adjusted p=0.028) in predicting postoperative 90-day mortality (CTP and MELDNa, adjusted p=0.543).
Conclusions: All three scoring systems predicted postoperative mortality in patients with cirrhosis. The predictability of 30-day mortality was equal among three systems. CTP score and MELDNa score were superior to MELD score in predicting postoperative 90-day mortality.