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Simplified model for end-stage liver disease score predicts mortality for tricuspid valve surgery
Kazumasa Tsuda1, Masaaki Koide, Yoshifumi Kunii
1Department of Cardiovascular Surgery, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan. umasa715@yahoo.co.jp
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.
Insights
A simplified Model for End-Stage Liver Disease (MELD) score, excluding the international normalized ratio (INR), effectively predicts mortality in tricuspid valve surgery patients. This score is useful for those on warfarin therapy.
Area of Science:
- Cardiology
- Hepatology
- Surgical Outcomes
Background:
- The standard Model for End-Stage Liver Disease (MELD) score is used to predict mortality in tricuspid valve surgery.
- Warfarin therapy complicates MELD score calculation due to its effect on the international normalized ratio (INR).
Purpose of the Study:
- To evaluate a simplified MELD score, excluding INR, for predicting mortality in patients undergoing tricuspid valve surgery.
- To determine the applicability of this simplified score in patients receiving warfarin therapy.
Main Methods:
- Retrospective analysis of 168 patients who underwent tricuspid valve surgery (replacement or repair).
- Calculation of a simplified MELD score using only total bilirubin and creatinine.
- Assessment of the relationship between the simplified MELD score and in-hospital mortality using univariate and multivariate analyses.
Main Results:
- In-hospital mortality was 6.4%.
- A higher simplified MELD score was independently associated with increased in-hospital mortality (P=0.001) and tricuspid valve replacement (P=0.023).
- Mortality rates increased significantly with higher simplified MELD score categories, and serious complications were more frequent in patients with a simplified MELD score ≥ 7.
Conclusions:
- The simplified MELD score accurately predicts mortality in patients undergoing tricuspid valve surgery.
- This simplified score, which omits INR, is suitable for patients on warfarin therapy.
