|Simplified model for end-stage liver disease score predicts mortality for tricuspid valve surgery.|
|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|
|Type: Journal Article Date: 2013-02-12|
|Title: Interactive cardiovascular and thoracic surgery Volume: 16 ISSN: 1569-9285 ISO Abbreviation: Interact Cardiovasc Thorac Surg Publication Date: 2013 May|
|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|
|Languages: eng Pagination: 630-5 Citation Subset: IM|
|APA/MLA Format Download EndNote Download BibTex|
Bilirubin / blood
Biological Markers / blood
Blood Coagulation / drug effects
Creatinine / blood
Heart Valve Diseases / blood, mortality, surgery*
Heart Valve Prosthesis Implantation / adverse effects, mortality*
International Normalized Ratio
Liver Diseases / blood, diagnosis*, mortality
Severity of Illness Index
Tricuspid Valve / surgery*
Warfarin / therapeutic use
|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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