Rapid Communication
Copyright ©2008 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Mar 21, 2008; 14(11): 1774-1780
Published online Mar 21, 2008. doi: 10.3748/wjg.14.1774
Model for end-stage liver disease score versus Child score in predicting the outcome of surgical procedures in patients with cirrhosis
Maarouf A Hoteit, Amaar H Ghazale, Andrew J Bain, Eli S Rosenberg, Kirk A Easley, Frank A Anania, Robin E Rutherford
Maarouf A Hoteit, Frank A Anania, Robin E Rutherford, Division of Digestive Diseases, Emory University, Atlanta, Georgia, United States
Amaar H Ghazale, Andrew J Bain, Department of Internal Medicine, Emory University, Atlanta, Georgia, United States
Eli S Rosenberg, Kirk A Easley, Department of Biostatistics-Rollins School of Public Health, Emory University, Atlanta, Georgia, United States
Correspondence to: Frank A Anania, MD, Emory University School of Medicine, Division of Digestive Diseases, 615 Michael Street, Suite 201, Atlanta, GA 30322, United States. fanania@emory.edu
Telephone: +1-404-7122867
Fax: +1-404-7122980
Received: September 3, 2007
Revised: December 10, 2007
Published online: March 21, 2008
Abstract

AIM: To determine factors affecting the outcome of patients with cirrhosis undergoing surgery and to compare the capacities of the Child-Turcotte-Pugh (CTP) and model for end-stage liver disease (MELD) score to predict that outcome.

METHODS: We reviewed the charts of 195 patients with cirrhosis who underwent surgery at two teaching hospitals over a five-year period. The combined endpoint of death or hepatic decompensation was considered to be the primary endpoint.

RESULTS: Patients who reached the endpoint had a higher MELD score, a higher CTP score and were more likely to have undergone an urgent procedure. Among patients undergoing elective surgical procedures, no statistically significant difference was noted in the mean MELD (12.8 ± 3.9 vs 12.6 ± 4.7, P = 0.9) or in the mean CTP (7.6 ± 1.2 vs 7.7 ± 1.7, P = 0.8) between patients who reached the endpoint and those who did not. Both mean scores were higher in the patients reaching the endpoint in the case of urgent procedures (MELD: 22.4 ± 8.7 vs 15.2 ± 6.4, P = 0.0007; CTP: 9.9 ± 1.8 vs 8.5 ± 1.8, P = 0.008). The performances of the MELD and CTP scores in predicting the outcome of urgent surgery were only fair, without a significant difference between them (AUC = 0.755 ± 0.066 for MELD vs AUC = 0.696 ± 0.070 for CTP, P = 0.3).

CONCLUSION: The CTP and MELD scores performed equally, but only fairly in predicting the outcome of urgent surgical procedures. Larger studies are needed to better define the factors capable of predicting the outcome of elective surgical procedures in patients with cirrhosis.

Keywords: Liver cirrhosis; Prognosis; Severity of illness index; Surgical procedures; Operative; Postoperative complications