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MELD-score for risk stratification in cardiac surgery.

Presheet Pathare1, Mohamed Elbayomi2, Michael Weyand2

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Heart and Vessels
|April 2, 2023
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Summary

The MELD score effectively predicts mortality in cardiac surgery patients, especially those with scores over 20. This score offers valuable insights beyond traditional risk calculators for improved patient outcomes.

Keywords:
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Area of Science:

  • Cardiology
  • Nephrology
  • Hepatology

Background:

  • Cardiac surgery outcomes are influenced by renal and hepatic function.
  • Current risk scores like EURO Score II and STS do not quantify these organ functions.
  • The Model for End-Stage Liver Disease (MELD) score, typically used for liver disease, can be applied to assess risk in cardiac surgery patients.

Purpose of the Study:

  • To evaluate the MELD score as a predictor of mortality in patients undergoing cardiac surgery with cardiopulmonary bypass.
  • To compare the predictive value of the MELD score against traditional risk stratification methods.

Main Methods:

  • Retrospective analysis of 10,882 patient records.
  • Patients were grouped by MELD score: <10 (Group 1), 10-19 (Group 2), and ≥20 (Group 3).
  • Primary outcome: postoperative in-hospital mortality. Secondary outcomes included bleeding, neurological complications, and need for support.

Main Results:

  • A higher MELD score correlated with increased postoperative mortality (Group 3: 31.2% vs. Group 1: 4.6%).
  • Group 3 also showed higher rates of bleeding, repeat thoracotomy, pneumonia, and need for dialysis or mechanical support.
  • MELD score did not significantly correlate with stroke/TIA or sternal wound infections.

Conclusions:

  • The MELD score is a valuable tool for predicting mortality and complications in cardiac surgery patients.
  • Applying the MELD score can enhance risk stratification beyond existing scores, particularly for patients with compromised renal and hepatic function.
  • Consideration of the MELD score is recommended prior to cardiac surgery to better inform patient selection and management.