Original articlesPredicting outcome after cardiac surgery in patients with cirrhosis: A comparison of Child-Pugh and MELD scores
Section snippets
Methods
The study was performed retrospectively with the approval of the institutional review board. Using computer coding, patients with cirrhosis who underwent cardiac surgery using CPB from January 1992 to June 2002 were identified. Their charts and computer records were studied. A diagnosis of cirrhosis was established from liver biopsy records or a combination of clinical findings and radiological imaging of the liver, including ultrasound, computed tomographic scan, or magnetic resonance imaging,
Statistical analysis
The outcome measures of hepatic decompensation and death were compared with a variety of explanatory variables, including age, sex, cause of cirrhosis, type of cardiac surgery, CP score and/or class, MELD score, bilirubin level, albumin level, international normalization ratio (INR), creatinine level, intubation time, CPB time, and anesthetic medications administered. Relationships between explanatory variables and outcome measures of hepatic decompensation and mortality were assessed by using
Results
Initially, 66 patients with possible cirrhosis undergoing cardiac surgery using CPB were identified. Twenty-two patients were excluded; 13 patients because the diagnosis of cirrhosis was not proven, and 9 patients because of unavailability of sufficient laboratory data. Forty-four patients with cirrhosis undergoing cardiac surgery using CPB were analyzed. Twenty-seven patients (61%) were men. Ages ranged from 15 to 74 years. Causes of cirrhosis were alcohol in 11 patients; hepatitis C,
Discussion
Our report on the outcome of cardiac surgery in patients with cirrhosis is the largest series published to date. Patients with well-compensated cirrhosis may safely undergo cardiac surgery using CPB. Our data show a similar and significant association of CP score and MELD score with hepatic decompensation and mortality. The best cutoff values of these scores for predicting mortality and hepatic decompensation were >7 for CP score and >13 for MELD score (Figure 3). Although both these cutoff
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