Document Detail

Simplified model for end-stage liver disease score predicts mortality for tricuspid valve surgery.
MedLine Citation:
PMID:  23403770     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: The model for end-stage liver disease score (MELD = 3.8*LN[total bilirubin] + 9.6*LN[creatinine] + 11.2*[PT-INR] + 6.4) predicts mortality for tricuspid valve surgery. However, the MELD is problematic in patients undergoing warfarin therapy, as warfarin affects the international normalized ratio (INR). This study aimed to determine whether a simplified MELD score that does not require the INR for calculation could predict mortality for patients undergoing tricuspid valve surgery. Simplified MELD score = 3.8*LN[total bilirubin] + 9.6*LN[creatinine] + 6.4.
METHODS: A total of 172 patients (male: 66, female: 106; mean age, 63.8 ± 10.3 years) who underwent tricuspid replacement (n = 18) or repair (n = 154) from January 1991 to July 2011 at a single centre were included. Of them, 168 patients in whom the simplified MELD score could be calculated were retrospectively analysed. The relationship between in-hospital mortality and perioperative variables was assessed by univariate and multivariate analysis.
RESULTS: The rate of in-hospital mortality was 6.4%. The mean admission simplified MELD score for the patients who died was significantly higher than for those surviving beyond discharge (11.3 ± 4.1 vs 5.8 ± 4.0; P = 0.001). By multivariate analysis, independent risk factors for in-hospital mortality included higher simplified MELD score (P = 0.001) and tricuspid valve replacement (P = 0.023). In-hospital mortality and morbidity increased along with increasing simplified MELD score. Scores <0, 0-6.9, 7-13.9 and >14 were associated with mortalities of 0, 2.0, 8.3 and 66.7%, respectively. The incidence of serious complications (multiple organ failure, P = 0.005; prolonged ventilation, P = 0.01; need for haemodialysis; P = 0.002) was also significantly higher in patients with simplified MELD score ≥ 7.
CONCLUSIONS: The simplified MELD score predicts mortality in patients undergoing tricuspid valve surgery. This model requires only total bilirubin and creatinine and is therefore applicable in patients undergoing warfarin therapy.
Kazumasa Tsuda; Masaaki Koide; Yoshifumi Kunii; Kazumasa Watanabe; Satoshi Miyairi; Yuko Ohashi; Takashi Harada
Publication Detail:
Type:  Journal Article     Date:  2013-02-12
Journal Detail:
Title:  Interactive cardiovascular and thoracic surgery     Volume:  16     ISSN:  1569-9285     ISO Abbreviation:  Interact Cardiovasc Thorac Surg     Publication Date:  2013 May 
Date Detail:
Created Date:  2013-04-22     Completed Date:  2013-11-04     Revised Date:  2014-05-07    
Medline Journal Info:
Nlm Unique ID:  101158399     Medline TA:  Interact Cardiovasc Thorac Surg     Country:  England    
Other Details:
Languages:  eng     Pagination:  630-5     Citation Subset:  IM    
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MeSH Terms
Bilirubin / blood
Biological Markers / blood
Blood Coagulation / drug effects
Creatinine / blood
Heart Valve Diseases / blood,  mortality,  surgery*
Heart Valve Prosthesis Implantation / adverse effects,  mortality*
Hospital Mortality
International Normalized Ratio
Liver Diseases / blood,  diagnosis*,  mortality
Logistic Models
Middle Aged
Multivariate Analysis
Odds Ratio
Retrospective Studies
Risk Assessment
Risk Factors
Severity of Illness Index
Time Factors
Treatment Outcome
Tricuspid Valve / surgery*
Warfarin / therapeutic use
Reg. No./Substance:
0/Biological Markers; 5Q7ZVV76EI/Warfarin; AYI8EX34EU/Creatinine; RFM9X3LJ49/Bilirubin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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