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Using noninvasive clinical parameters to predict mortality and morbidity after cardiac interventions in patients with
Christo Mathew1, Ankur Patel1, George Cholankeril1,2
1Department of Internal Medicine, Baylor College of Medicine, Houston, Texas, USA.
Insights
Clinical scores like MELD and CPT predict mortality and complications in patients with advanced liver disease undergoing cardiac procedures. This aids proceduralists in managing high-risk patients.
Area of Science:
- Cardiology
- Hepatology
- Medical Interventions
Background:
- Cardiovascular disease is prevalent in advanced liver disease patients, necessitating cardiac interventions.
- Cirrhosis significantly elevates risks of complications and mortality post-cardiac procedures, creating a clinical challenge.
- Accurate outcome prediction is vital for managing patients with cirrhosis undergoing interventions.
Approach:
- Systematic review of PubMed and EMBASE databases (up to January 8, 2023).
- Inclusion of studies reporting clinical scores (MELD, CPT), cardiovascular interventions, and mortality/morbidity outcomes.
- Independent data abstraction and qualitative synthesis of eligible studies.
Key Points:
- Eight studies involving various cardiac procedures (e.g., valve surgery, LVAD) were included.
- Model for End-stage Liver Disease (MELD) and Child-Pugh-Turcotte (CPT) scores were primary mortality predictors.
- Elevated MELD (>15) correlated with increased mortality after tricuspid valve surgery; MELD, albumin, and creatinine predicted TAVR mortality.
Conclusions:
- Clinical parameters effectively predict mortality and morbidity in patients with cirrhosis undergoing cardiac procedures.
- MELD and CPT scores are crucial for risk stratification in this patient population.
- This systematic review provides evidence for utilizing clinical scores in peri-procedural decision-making.
Background:
Cardiovascular disease commonly affects advanced liver disease patients. They undergo cardiac interventions to improve cardiac outcomes. Cirrhosis increases complication risk, including bleeding, renal and respiratory failure, and further decompensation, including death, posing a clinical dilemma to proceduralists. Predicting outcomes is crucial in managing patients with cirrhosis. Our aim was to systematically review clinical parameters to assess the mortality and complication risk in patients with cirrhosis undergoing cardiac interventions.
Methods:
We searched cirrhosis and cardiovascular intervention terminology in PubMed and Excerpta Medica Database (EMBASE) from inception to January 8, 2023. We included studies reporting clinical scores (e.g. Model for End-stage Liver Disease (MELD), Child-Pugh-Turcotte (CPT), cardiovascular interventions, mortality, and morbidity outcomes). We independently abstracted data from eligible studies and performed qualitative summaries.
Results:
Eight studies met the inclusion criteria. Procedures included tricuspid valve surgery, catheterization-related procedures, aortic valve replacement (AVR), pericardiectomy, and left ventricular assist device (LVAD) placement. MELD primarily predicted mortality (n = 4), followed by CPT (n = 2). Mortality is significantly increased for MELD > 15 after tricuspid valve surgery. Albumin, creatinine, and MELD were significantly associated with increased mortality after transcatheter AVR (TAVR), although specific values lacked stratification. CPT was significantly associated with increased mortality after cardiac catheterization or pericardiectomy. In LVAD placement, increasing MELD increased the unadjusted odds for perioperative mortality.
Conclusions:
Our systematic review showed that clinical parameters predict mortality and morbidity risk in patients with cirrhosis undergoing cardiac procedures.
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