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Journal ArticleDOI

Risk factors for mortality after surgery in patients with cirrhosis.

01 Apr 2007-Gastroenterology (Elsevier)-Vol. 132, Iss: 4, pp 1261-1269
TL;DR: 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 and can be used in determining operative mortality risk and whether elective surgical procedures can be delayed until after liver transplantation.
About: This article is published in Gastroenterology.The article was published on 2007-04-01. It has received 438 citations till now. The article focuses on the topics: Risk of mortality & Model for End-Stage Liver Disease.
Citations
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Journal ArticleDOI
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.

1,377 citations

Journal ArticleDOI
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.
Abstract: Institutional Affiliations Co-chairs Feldman D: Minneapolis Heart Institute, Minneapolis, Minnesota, Georgia Institute of Technology and Morehouse School of Medicine; Pamboukian SV: University of Alabama at Birmingham, Birmingham, Alabama; Teuteberg JJ: University of Pittsburgh, Pittsburgh, Pennsylvania Task force chairs Birks E: University of Louisville, Louisville, Kentucky; Lietz K: Loyola University, Chicago, Maywood, Illinois; Moore SA: Massachusetts General Hospital, Boston, Massachusetts; Morgan JA: Henry Ford Hospital, Detroit, Michigan Contributing writers Arabia F: Mayo Clinic Arizona, Phoenix, Arizona; Bauman ME: University of Alberta, Alberta, Canada; Buchholz HW: University of Alberta, Stollery Children’s Hospital and Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada; Deng M: University of California at Los Angeles, Los Angeles, California; Dickstein ML: Columbia University, New York, New York; El-Banayosy A: Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania; Elliot T: Inova Fairfax, Falls Church, Virginia; Goldstein DJ: Montefiore Medical Center, New York, New York; Grady KL: Northwestern University, Chicago, Illinois; Jones K: Alfred Hospital, Melbourne, Australia; Hryniewicz K: Minneapolis Heart Institute, Minneapolis, Minnesota; John R: University of Minnesota, Minneapolis, Minnesota; Kaan A: St. Paul’s Hospital, Vancouver, British Columbia, Canada; Kusne S: Mayo Clinic Arizona, Phoenix, Arizona; Loebe M: Methodist Hospital, Houston, Texas; Massicotte P: University of Alberta, Stollery Children’s Hospital, Edmonton, Alberta, Canada; Moazami N: Minneapolis Heart Institute, Minneapolis, Minnesota; Mohacsi P: University Hospital, Bern, Switzerland; Mooney M: Sentara Norfolk, Virginia Beach, Virginia; Nelson T: Mayo Clinic Arizona, Phoenix, Arizona; Pagani F: University of Michigan, Ann Arbor, Michigan; Perry W: Integris Baptist Health Care, Oklahoma City, Oklahoma; Potapov EV: Deutsches Herzzentrum Berlin, Berlin, Germany; Rame JE: University of Pennsylvania, Philadelphia, Pennsylvania; Russell SD: Johns Hopkins, Baltimore, Maryland; Sorensen EN: University of Maryland, Baltimore, Maryland; Sun B: Minneapolis Heart Institute, Minneapolis, Minnesota; Strueber M: Hannover Medical School, Hanover, Germany Independent reviewers Mangi AA: Yale University School of Medicine, New Haven, Connecticut; Petty MG: University of Minnesota Medical Center, Fairview, Minneapolis, Minnesota; Rogers J: Duke University Medical Center, Durham, North Carolina

1,152 citations


Cites background from "Risk factors for mortality after su..."

  • ...Preoperative coagulopathies are common in heart failure patients due to hepatic dysfunction and the use of anti-coagulant or anti-platelet medications.(40) When possible, these medications should be stopped prior to implant....

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Journal ArticleDOI
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.

648 citations

Journal ArticleDOI
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.
Abstract: This guide to the practical treatment of patients with cirrhosis summarizes recent developments. It includes advice on medical management, invasive procedures, nutrition, prevention, and strategies to protect the cirrhotic liver from harm.

238 citations

Journal ArticleDOI
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.

235 citations


Cites background from "Risk factors for mortality after su..."

  • ...In these patients, multiple organ failure as reflected by an American Society for Anesthesia score of V was the only variable associated with 7 day postoperative mortality.(11) Because of limited prospective data from the East, a consensus working definition of “ACLF” that serves at this time only to identify patients from whom data are to be collected to...

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  • ...The AASLD/EASL consensus proposed a period of increased mortality risk of 3 months based on data on ACLF that develops in patients with compensated cirrhosis undergoing major surgery.(11) Cirrhotic patients may develop rapid hepatic decompensation and then multiple organ failure after surgery; most patients develop infections before death....

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References
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Journal ArticleDOI
TL;DR: The method of classifying comorbidity provides a simple, readily applicable and valid method of estimating risk of death fromComorbid disease for use in longitudinal studies and further work in larger populations is still required to refine the approach.

39,961 citations

Book
11 Aug 2000
TL;DR: A Cox Model-based approach was used to estimate the Survival and Hazard Functions and the results confirmed the need for further investigation into the role of natural disasters in shaping survival rates.
Abstract: Introduction.- Estimating the Survival and Hazard Functions.- The Cox Model.- Residuals.- Functional Form.- Testing Proportional Hazards.- Influence.- Multiple Events per Subject.- Frailty Models.- Expected Survival.

5,201 citations


Additional excerpts

  • ...Median age, y 63 61 64 62.5 64 63.5 65 67 60.5 Median MELD score 8 8 7 8 7.5 7 6 10 8 ASA class IV or Vf 142 ( 18 ) 55 (24) 6 (4) 31 (30) 14 (13) 7 (14) 3 (5) 17 (41) 9 (24) Men 430 (56) 123 (53) 89 (64) 46 (45) 62 (55) 28 (56) 24 (42) 31 (76) 27 (71) Etiology of cirrhosis...

    [...]

  • ...Alcoholic 182 (24) 56 (24) 26 (19) 28 (27) 14 (13) 24 (48) 14 (25) 12 (29) 8 (21) Viral 141 (18) 28 (12) 46 (33) 16 (16) 18 (16) 7 (14) 11 (19) 8 (20) 7 (18) Cholestatic 142 ( 18 ) 51 (22) 17 (12) 21 (21) 22 (20) 9 (18) 13 (23) 5 (12) 4 (11) Other 307 (40) 98 (42) 50 (36) 37 (36) 58 (52) 10 (20) 19 (33) 16 (39) 19 (50)...

    [...]

  • ...Alcoholic 182 (24) 56 (24) 26 (19) 28 (27) 14 (13) 24 (48) 14 (25) 12 (29) 8 (21) Viral 141 (18) 28 (12) 46 (33) 16 (16) 18 (16) 7 (14) 11 (19) 8 (20) 7 ( 18 ) Cholestatic 142 (18) 51 (22) 17 (12) 21 (21) 22 (20) 9 (18) 13 (23) 5 (12) 4 (11) Other 307 (40) 98 (42) 50 (36) 37 (36) 58 (52) 10 (20) 19 (33) 16 (39) 19 (50)...

    [...]

  • ...Alcoholic 182 (24) 56 (24) 26 (19) 28 (27) 14 (13) 24 (48) 14 (25) 12 (29) 8 (21) Viral 141 ( 18 ) 28 (12) 46 (33) 16 (16) 18 (16) 7 (14) 11 (19) 8 (20) 7 (18) Cholestatic 142 (18) 51 (22) 17 (12) 21 (21) 22 (20) 9 (18) 13 (23) 5 (12) 4 (11) Other 307 (40) 98 (42) 50 (36) 37 (36) 58 (52) 10 (20) 19 (33) 16 (39) 19 (50)...

    [...]

  • ...Alcoholic 182 (24) 56 (24) 26 (19) 28 (27) 14 (13) 24 (48) 14 (25) 12 (29) 8 (21) Viral 141 (18) 28 (12) 46 (33) 16 (16) 18 (16) 7 (14) 11 (19) 8 (20) 7 (18) Cholestatic 142 (18) 51 (22) 17 (12) 21 (21) 22 (20) 9 ( 18 ) 13 (23) 5 (12) 4 (11) Other 307 (40) 98 (42) 50 (36) 37 (36) 58 (52) 10 (20) 19 (33) 16 (39) 19 (50)...

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Journal ArticleDOI
TL;DR: The MELD scale is a reliable measure of mortality risk in patients with end‐stage liver disease and suitable for use as a disease severity index to determine organ allocation priorities in patient groups with a broader range of disease severity and etiology.

4,184 citations

Journal ArticleDOI
TL;DR: This Mayo TIPS model may predict early death following elective TIPS for either prevention of variceal rebleeding or for treatment of refractory ascites, superior to both the Child‐Pugh classification and the Child-Pugh score in predicting survival.

2,479 citations


Additional excerpts

  • ...5 7 6 10 8 ) 14 (13) 7 (14) 3 (5) 17 (41) 9 (24) ) 62 (55) 28 (56) 24 (42) 31 (76) 27 (71)...

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Journal ArticleDOI
TL;DR: The natural history of cirrhosis is outlined, the model for end stage liver disease (MELD) has replaced the Child–Pugh score in the United States for prioritizing liver donor allocation and a systematic review of the literature regarding predictors of mortality in cirrhotic patients is reported on.

2,427 citations