Open Access
CLINICAL-LIVER, PANCREAS, AND BILIARY TRACT Risk Factors for Mortality After Surgery in Patients With Cirrhosis
Swee H. Teh,David M. Nagorney,Susanna R. Stevens,Kenneth P. Offord,Terry M. Therneau,David J. Plevak,Jayant A. Talwalkar,W. Ray Kim,Patrick S. Kamath +8 more
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TLDR
In this article, the authors used the Model for End-stage Liver Disease (MELD) to predict post-operative mortality in patients with cirrhosis after surgery other than liver transplantation.Abstract:
BACKGROUND & AIMS
Current methods of predicting risk of postoperative mortality in patients with cirrhosis are suboptimal. The utility of the Model for End-stage Liver Disease (MELD) in predicting mortality after surgery other than liver transplantation is unknown. The aim of this study was to determine the risk factors for postoperative mortality in patients with cirrhosis.
METHODS
Patients with cirrhosis (N = 772) who underwent major digestive (n = 586), orthopedic (n = 107), or cardiovascular (n = 79) surgery were studied. Control groups of patients with cirrhosis included 303 undergoing minor surgical procedures and 562 ambulatory patients. Univariate and multivariable proportional hazards analyses were used to determine the relationship between risk factors and mortality.
RESULTS
Patients undergoing major surgery were at increased risk for mortality up to 90 days postoperatively. By multivariable analysis, only MELD score, American Society of Anesthesiologists class, and age predicted mortality at 30 and 90 days, 1 year, and long-term, independently of type or year of surgery. Emergency surgery was the only independent predictor of duration of hospitalization postoperatively. Thirty-day mortality ranged from 5.7% (MELD score, <8) to more than 50% (MELD score, >20). The relationship between MELD score and mortality persisted throughout the 20-year postoperative period.
CONCLUSIONS
MELD score, age, and American Society of Anesthesiologists class can quantify the risk of mortality postoperatively in patients with cirrhosis, independently of the procedure performed. These factors can be used in determining operative mortality risk and whether elective surgical procedures can be delayed until after liver transplantation.read more
Citations
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Journal ArticleDOI
The model for end-stage liver disease (MELD)
Patrick S. Kamath,W. Ray Kim +1 more
TL;DR: The Model for End‐stage Liver Disease was initially created to predict survival in patients with complications of portal hypertension undergoing elective placement of transjugular intrahepatic portosystemic shunts and was validated subsequently as an accurate predictor of survival among different populations of patients with advanced liver disease.
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The 2013 International Society for Heart and Lung Transplantation Guidelines for mechanical circulatory support: executive summary.
David S. Feldman,Salpy V. Pamboukian,Jeffrey J. Teuteberg,Emma J. Birks,Katherine Lietz,Stephanie A. Moore,Jeffrey A. Morgan,Francisco A. Arabia,Mary E. Bauman,Hoger W. Buchholz,Mario Eng,Marc L. Dickstein,Aly El-Banayosy,Tonya Elliot,Daniel J. Goldstein,Kathleen L. Grady,Kylie Jones,K. Hryniewicz,Ranjit John,Annemarie Kaan,Shimon Kusne,Matthias Loebe,M. Patricia Massicotte,Nader Moazami,Paul Mohacsi,Martha L. Mooney,Thomas A. Nelson,Francis D. Pagani,William C. Perry,Evgenij V. Potapov,J. Eduardo Rame,Stuart D. Russell,Erik N. Sorensen,Benjamin Sun,Martin Strueber,Abeel A. Mangi,Michael Petty,Joseph G. Rogers,Amanda W. Rowe +38 more
TL;DR: Institutional Affiliations Co-chairs Feldman D: Minneapolis Heart Institute, Minneapolis, Minnesota, Georgia Institute of Technology and Morehouse School of Medicine, and Pamboukian SV: University of Alabama at Birmingham, Birmingham, Alabama, Teuteberg JJ:University of Pittsburgh, Pittsburgh, Pennsylvania Task force chairs.
Journal ArticleDOI
Acute-on chronic liver failure
Rajiv Jalan,Pere Ginès,Jody C. Olson,Rajeshwar P. Mookerjee,Richard Moreau,Guadalupe Garcia-Tsao,Vicente Arroyo,Patrick S. Kamath +7 more
TL;DR: In this paper, the authors focus on the current understanding of acute-on-chronic liver failure from the clinical, prognostic and pathophysiological perspectives and indicate potential biomarkers and therapeutic targets for intervention.
Journal ArticleDOI
Treatment of Patients with Cirrhosis.
Phillip S. Ge,Bruce A. Runyon +1 more
TL;DR: This guide to the practical treatment of patients with cirrhosis summarizes recent developments and includes advice on medical management, invasive procedures, nutrition, prevention, and strategies to protect the cirrhotic liver from harm.
Journal ArticleDOI
Toward an Improved Definition of Acute-on-Chronic Liver Failure
Rajiv Jalan,Cihan Yurdaydin,Jasmohan S. Bajaj,Subrat K. Acharya,Vicente Arroyo,Han Chieh Lin,Pere Ginès,W. Ray Kim,Patrick S. Kamath +8 more
TL;DR: A perspective serves to resolve some of issues and outline an approach to better define acuteon-chronic liver failure (ACLF), which has resulted in confusion rather than clarification of the problem.
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A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts.
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