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Postoperative Meld-Lactate and Isolated Lactate Values As Outcome Predictors Following Orthotopic Liver
Sang Kim1, Jeron Zerillo, Parissa Tabrizian
1*Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, New York, New York †Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, New York ‡Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York §Anesthesiology Institute, Cleveland Clinic Florida, Weston, Florida.
Abstract:
The Model for End Stage Liver (MELD) score is validated to predict pretransplant mortality. However, as a predictor of postoperative outcomes, its utility has proven inconsistent. Recently developed MELD-Lactate models better predict 30-day survival as compared with the MELD and MELD-Sodium scores. We compared the MELD-Lactate, original MELD, and MELD-Sodium formulae and the initial postoperative lactate as predictors of 30-day and in-hospital mortality following liver transplantation.Adult patients (n = 989) undergoing orthotopic liver transplant between 2002 to 2013 were included. In addition to the previous models, the first postoperative lactate value and a newly derived Mount Sinai MELD-Lactate score and associated c-statistics were compared.The Mount Sinai MELD-Lactate model yielded the highest c-statistic value (0.749), followed by the original MELD-Lactate (0.740), initial lactate value (0.729), postoperative MELD (0.653), and MELD-Sodium (0.641) models in predicting survival at 30 days following liver transplantation. For in-hospital mortality, the original MELD-Lactate model had slightly higher c-statistic (0.739) compared with the Mount Sinai MELD-Lactate model (0.734). Despite the distribution differences in the MELD-Lactate models, the model validation results, both from cross-validation and bootstrap methods, were similar.Postoperative MELD-Lactate and isolated postoperative lactate values were moderately predictive of 30-day and in-hospital mortality following liver transplantation in this patient cohort.
Insights
The MELD-Lactate score, incorporating lactate levels, shows improved prediction of mortality after liver transplantation compared to MELD and MELD-Sodium scores. Postoperative lactate alone also offers moderate predictive value for patient survival.
Area of Science:
- Hepatology
- Transplant Surgery
- Critical Care Medicine
Background:
- The Model for End Stage Liver (MELD) score is established for predicting pretransplant mortality but shows inconsistent utility for postoperative outcomes.
- MELD-Lactate models have emerged as potentially better predictors of short-term survival post-liver transplant.
Purpose of the Study:
- To compare the predictive accuracy of MELD-Lactate, MELD, MELD-Sodium, and initial postoperative lactate for 30-day and in-hospital mortality after liver transplantation.
- To evaluate a newly derived Mount Sinai MELD-Lactate score against existing models.
Main Methods:
- Retrospective analysis of 989 adult patients undergoing orthotopic liver transplant from 2002 to 2013.
- Comparison of predictive performance using c-statistics for various models including MELD-Lactate, MELD, MELD-Sodium, and initial postoperative lactate.
- Validation of models using cross-validation and bootstrap methods.
Main Results:
- The Mount Sinai MELD-Lactate model demonstrated the highest c-statistic (0.749) for predicting 30-day survival, followed by MELD-Lactate (0.740) and initial lactate (0.729).
- For in-hospital mortality, the original MELD-Lactate model showed a slightly higher c-statistic (0.739) than the Mount Sinai MELD-Lactate model (0.734).
- Postoperative MELD-Lactate and isolated postoperative lactate values were found to be moderately predictive of both 30-day and in-hospital mortality.
Conclusions:
- MELD-Lactate models and initial postoperative lactate levels offer improved prediction of mortality following liver transplantation compared to traditional MELD and MELD-Sodium scores.
- These lactate-based models provide valuable prognostic information for short-term outcomes in liver transplant recipients.
