Cardiac surgery in patients with liver cirrhosis: Risk factors for predicting mortality

Table 1 Patient demographics stratified by Child-Turcotte-Pugh classification

	All patients	Child-Turcotte-Pugh Class
		A	B and C	P value
Case number	55	30	25
Male gender	43	22	21	0.514
Median age in years	60 (51, 71)	64.5 (56, 71)	53 (45, 63)	0.025
Co-morbidities
Diabetes mellitus	15	13	2	0.005
Hypertension	16	12	4	0.075
Etiology of liver cirrhosis
Viral	32	21	11	0.052
Alcoholic	13	7	6	0.954
Cardiac	8	1	7	0.018
Pre-operative serum level
Bilirubin (mg/dL)	1.3 (0.9, 2.4)	1.01 (0.84, 1.37)	2.41 (1.11, 4.13)	< 0.001
Albumin (g/dL)	3.6 (3.1, 4.0)	3.8 (3.3, 4.2)	3.1 (2.8, 3.7)	0.002
INR	1.2 (1.1, 1.3)	1.14 (1.04, 1.2)	1.3 (1.15, 1.5)	0.001
Platelet count (K/L)	119 (91, 176)	127.5 (94, 199)	119 (82, 147)	0.163
Hemoglobin (g/dL)	11.2 (9.6, 13.1)	12.4 (11, 13.7)	10.3 (9.4, 11.6)	0.005
Creatinine (mg/dL)	1.2 (1.0, 1.9)	1.2 (0.9, 1.6)	1.2 (1, 2)	0.762
MELD Score	11 (8, 16)	9 (7, 11)	15 (11, 22)	< 0.001
EuroSCORE	2.6 (1.6, 3.6)	2.8 (2, 4.8)	2.2 (1.5, 3.1)	0.168
Operation-related variables
Emergency operation	13	7	6	1.000
CABG	13	10	3	0.110
OPCAB	7	6	1	0.112
Postoperative complications
Bleeding	9	3	6	0.273
Cardiac	18	8	10	0.294
Pulmonary	11	7	4	0.736
Gastrointestinal	2	1	1	1.000
Hepatic	12	4	8	0.114
Renal	14	6	8	0.309
Neurological	7	3	4	0.689
Infectious	16	8	8	0.665
ICU stay in days	3 (2, 13)	3 (2, 7.5)	3 (2, 16)	0.368
Hospital stay in days	17 (12, 36)	13.5 (10, 32)	27 (16, 41)	0.042
Mortality
In-hospital	9 (16.4%)	5 (16.7%)	4 (16%)	1.000
3-mo	10	5	5	0.750
1-yr	15	6	9	0.136
2-yr	17	8	9	0.391
3-yr	18	9	9	0.890
5-yr	20	10	10	0.709
Follow-up duration (mo)	28.6 (3.2, 68.4)	31.4 (5.6, 64.3)	22.8 (3.0, 62.4)	0.697

Continuous variables were expressed as the median (interquartile range). CABG: Coronary artery bypass grafting; ICU: Intensive care unit; INR: International normalized ratio; MELD: Model for end-stage liver disease; OPCAB: Off-pump coronary artery bypass surgery; WBC: White blood cell count.

Table 2 Risk factors for death by stepwise logistic regression at different times after operation: odds ratios with P value < 0.05

	In-hospital	3 mo	1 yr	2 yr	3 yr	5 yr
Patient number	55	55	50	47	41	36
Death	9	10	15	17	18	20
Mortality rate (%)	16.4	18.2	30	36.2	43.9	55.6
Bilirubin			1.86 (1.11-3.14)	1.83 (1.05-3.20)	1.74 (1.04-2.89)	1.87 (1.02-3.42)
EuroSCORE	2.17b (1.32-3.59)	1.92b (1.19-3.09)	1.68 (1.10-2.58)	1.57 (1.04-2.37)
CABG		7.14 (1.12-45.58)			9.00 (1.71-47.48)	10.62 (1.64-68.84)

Data are expressed as odds ratio (95%CI).

^bP < 0.01 vs control. CABG: Coronary artery bypass grafting.

Table 3 Risk factor for death by Cox hazard proportional models-hazard ratios

	Crude	Full model	Reduced model
Male gender	0.30b (0.13-0.68)	0.26b (0.10-0.69)	0.32b (0.14-0.75)
Bilirubin	1.26a (1.03-1.55)	1.22 (0.96-1.55)	1.24a (1.01-1.54)
EuroSCORE	1.44b (1.22-1.71)	1.46b (1.18-1.81)	1.42b (1.15-1.74)
Multiple procedures	2.53a (1.08-5.91)	1.31 (0.51-3.37)
CABG	2.90a (1.25-6.75)	4.05b (1.47-11.20)	3.34b (1.33-8.38)

^aP < 0.05;

^bP < 0.01 vs control. CABG: Coronary arteries bypass grafting.