Model for end-stage liver disease predicts mortality for tricuspid valve surgery.
Model for end-stage liver disease predicts mortality for tricuspid valve surgery.
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DOI：
10.1016/j.athoracsur.2009.01.043
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发表时间：
2009-05
影响因子：
4.6
通讯作者：
Kron, Irving L.
中科院分区：
文献类型：
--
作者：
Ailawadi, Gorav;LaPar, Damien J.;Swenson, Brian R.;Siefert, Suzanne A.;Lau, Christine;Kern, John A.;Peeler, Benjamin B.;Littlewood, Keith E.;Kron, Irving L.
接受三尖瓣手术的患者死亡率为 9.8%，考虑到手术的复杂性，该死亡率高于预期。尽管许多三尖瓣疾病患者出现肝功能障碍，但现有的风险模型还没有解释这一点。终末期肝病模型 (MELD) 评分可准确预测腹部手术的死亡率。本研究的目的是确定 MELD 是否能够准确预测三尖瓣手术后的死亡率，并将其与现有的风险模型进行比较。从 1994 年到 2008 年，168 名患者（平均年龄 61 ± 14 岁；男性 = 72 名，女性 = 96 名）接受了三尖瓣修复术（n = 156）或置换术（n = 12）。 87% 的患者进行了伴随手术（168 例中的 146 例）。将有肝硬化病史或 MELD 评分 15 或以上的患者（MELD = 3.8*LN [总胆红素] + 11.2*对数正常值 [国际标准化比值] + 9.6*对数正常值 [肌酐] + 6.4）与无肝病或 MELD 评分低于 15 的患者进行比较。评估术前风险、术中发现以及包括手术死亡率在内的并发症。使用 χ2、Fisher 精确检验和曲线下面积 (AUC) 分析进行统计分析。有肝病史或 MELD 评分为 15 或更高的患者死亡率显着较高（18.9% [37 名中的 7 名] 对比 6.1% [131 名中的 8 名]，p = 0.024）。为了进一步表征 MELD 的效果，仅通过 MELD 对患者进行分层。各组之间在人口统计或操作方面没有发现重大差异。死亡率随着 MELD 评分的增加而增加，特别是当 MELD 评分为 15 或更高时 (p = 0.0015)。 MELD评分低于10、10至14.9、15至19.9和超过20分别与1.9%、6.8%、27.3%和30.8%的手术死亡率相关。通过多变量分析，MELD 评分为 15 或更高仍然与死亡率密切相关 (p = 0.0021)。 MELD 评分预测死亡率（AUC = 0.78）以及欧洲心脏手术风险评估系统逻辑风险计算器（AUC = 0.78，p = 0.96）。 MELD 评分可以预测接受三尖瓣手术的患者的死亡率，并为这些患者提供一种简单有效的风险分层方法。
Patients undergoing tricuspid valve surgery have a mortality of 9.8%, which is higher than expected given the complexity of the procedure. Despite liver dysfunction seen in many patients with tricuspid disease, no existing risk model accounts for this. The Model for End-Stage Liver Disease (MELD) score accurately predicts mortality for abdominal surgery. The objective of this study was to determine if MELD could accurately predict mortality after tricuspid valve surgery and compare it to existing risk models. From 1994 to 2008, 168 patients (mean age, 61 ± 14 years; male = 72, female = 96) underwent tricuspid repair (n = 156) or replacement (n = 12). Concomitant operations were performed in 87% (146 of 168). Patients with history of cirrhosis or MELD score 15 or greater (MELD = 3.8*LN [total bilirubin] + 11.2*log normal [international normalized ratio] + 9.6*log normal [creatinine] + 6.4) were compared with patients without liver disease or MELD score less than 15. Preoperative risk, intraoperative findings, and complications including operative mortality were evaluated. Statistical analyses were performed using χ2, Fisher’s exact test, and area under the curve (AUC) analyses. Patients with a history of liver disease or MELD score of 15 or greater had significantly higher mortality (18.9% [7 of 37] versus 6.1% [8 of 131], p = 0.024). To further characterize the effect of MELD, patients were stratified by MELD alone. No major differences in demographics or operation were identified between groups. Mortality increased as MELD score increased, especially when MELD score of 15 or greater (p = 0.0015). A MELD score less than 10, 10 to 14.9, 15 to 19.9, and more than 20 was associated with operative mortality of 1.9%, 6.8%, 27.3%, and 30.8%, respectively. By multivariate analysis, MELD score of 15 or greater remained strongly associated with mortality (p = 0.0021). The MELD score predicted mortality (AUC = 0.78) as well as the European System for Cardiac Operative Risk Evaluation logistic risk calculator (AUC = 0.78, p = 0.96). The MELD score predicts mortality in patients undergoing tricuspid valve surgery and offers a simple and effective method of risk stratification in these patients.
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影响因子：
37.8
作者：
Ivanov, J;Tu, JV;Naylor, CD
通讯作者：
Naylor, CD
影响因子：
2.5
作者：
Nishi, Hiroyuki;Takahashi, Toshiki;Sawa, Yoshiki
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Sawa, Yoshiki
影响因子：
3.4
作者：
Nashef, SAM;Rogues, F;Salamon, R
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Salamon, R
影响因子：
13.2
作者：
Anderson, RJ;O'Brien, M;Shroyer, L
通讯作者：
Shroyer, L
影响因子：
3
作者：
Farnsworth, N;Fagan, SP;Awad, SS
通讯作者：
Awad, SS