Document Detail


Simplified model for end-stage liver disease score predicts mortality for tricuspid valve surgery.
MedLine Citation:
PMID:  23403770     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
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
Descriptor/Qualifier:
Aged
Bilirubin / blood
Biological Markers / blood
Blood Coagulation / drug effects
Comorbidity
Creatinine / blood
Female
Heart Valve Diseases / blood,  mortality,  surgery*
Heart Valve Prosthesis Implantation / adverse effects,  mortality*
Hospital Mortality
Humans
International Normalized Ratio
Japan
Liver Diseases / blood,  diagnosis*,  mortality
Logistic Models
Male
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
Chemical
Reg. No./Substance:
0/Biological Markers; 5Q7ZVV76EI/Warfarin; AYI8EX34EU/Creatinine; RFM9X3LJ49/Bilirubin
Comments/Corrections

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