Child-Turcotte-Pugh versus MELD score as a predictor of outcome after elective and emergent surgery in cirrhotic patients
Child-Turcotte-Pugh versus MELD score as a predictor of outcome after elective and emergent surgery in cirrhotic patients
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DOI：
10.1016/j.amjsurg.2004.07.034
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发表时间：
2004-11-01
影响因子：
3
通讯作者：
Awad, SS
中科院分区：
文献类型：
--
作者：
Farnsworth, N;Fagan, SP;Awad, SS
背景：肝硬化患者的选择性和紧急手术对外科医生来说是一个巨大的挑战，因为高发病率和死亡率的报道。child - turcote - pugh （CTP）评分以前被用于评估术前肝功能障碍的严重程度和预测术后预后。最近，一种更客观的评分分类——终末期肝病（MELD）模型——被证明可以准确预测等待移植的肝硬化患者3个月的死亡率。我们试图比较CTP和MELD评分在预测需要全身麻醉的肝硬化手术患者预后方面的作用。方法：在研究期间，回顾了40例在全身麻醉下需要选择性(E)或紧急（EM）手术的肝硬化病史患者（E = 24, EM = 16）。计算术前CTP和MELD评分，记录患者短期（30天）和长期（3个月）结果。结果：急诊组与择期组1个月、3个月死亡率比较差异有统计学意义（EM组1个月= 19%，3个月= 44%；E组1个月= 17%，3个月= 21%,P < 0.05）。CP与MELD评分之间存在良好的相关性，急诊组的相关性高于择期组（EM: r = 0.81; E: r = 0.65）。结论：我们的研究表明，在全身麻醉下接受手术的肝硬化患者1个月和3个月的死亡率极高，并且随着术前肝功能障碍的严重程度逐渐增加。此外，MELD评分与CTP评分具有良好的相关性，为肝硬化手术患者术后死亡率提供了更客观的预测指标。(C) 2004年摘录医药股份有限公司版权所有。
Background: Cirrhotic patients who present for elective and emergent surgery pose a formidable challenge for the surgeon because of the high reported morbidity and mortality. The Child-Turcotte-Pugh (CTP) score previously has been used to evaluate preoperative severity of liver dysfunction and to predict postoperative outcome. Recently, a more objective scoring classification, the model for end-stage liver disease (MELD), has been shown to predict accurately the 3-month mortality for cirrhotic patients awaiting transplantation. We sought to compare the CTP and MELD scores in predicting outcomes in Cirrhotic patients undergoing surgical procedures requiring general anesthesia.Methods: During the study period, 40 patients with a history of cirrhosis who required elective (E) or emergent (EM) surgical procedures under general anesthesia were reviewed (E = 24, EM = 16). The preoperative CTP and MELD scores were calculated and patient short(30-day) and long-term (3-month) outcomes were recorded.Results: There was a significant difference in the 1-month and 3-month mortality rates between the emergent and elective groups (EM group: 1 mo = 19%, 3 mo = 44%; E group: 1 mo = 17%, 3 mo = 21 %, P < 0.05). There was good correlation between the CP and MELD scores, which was greater in the emergent groups as compared with the elective group (EM: r = 0.81; E: r = 0.65).Conclusions: Our study shows that cirrhotic patients who undergo surgery under general anesthesia have an extremely high 1 - and 3-month mortality rate that progressively increases with severity of preoperative liver dysfunction. Additionally, the MELD score correlates well with the CTP score, providing a more objective predictor of postoperative mortality in cirrhotic patients undergoing surgery. (C) 2004 Excerpta Medica, Inc. All rights reserved.