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Outcomes of Cardiac Surgery in Patients With Liver Cirrhosis: A Systematic Review and Meta-Analysis
Abhiraj Saxena1,2, Rob Tatum2,3, Hui Chen2,4
1From the Department of Medicine, Rutgers Health Robert Wood Johnson, New Brunswick, NJ.
Insights
The Child-Pugh score, a liver disease severity classification, predicts outcomes for cardiac surgery patients. Preoperative Child-Pugh classification significantly impacts survival, unlike the MELD score.
Area of Science:
- Cardiology
- Hepatology
- Medical Statistics
Background:
- Cirrhosis significantly increases patient morbidity and mortality.
- Child-Pugh and MELD scores predict outcomes but lack granular analysis in cardiac surgery patients with liver disease.
Purpose of the Study:
- To analyze the association between liver disease severity (Child-Pugh and MELD scores) and clinical outcomes in patients undergoing cardiac surgery.
- To evaluate the predictive value of preoperative disease severity scores for postoperative outcomes in this population.
Main Methods:
- Meta-analysis of continuous and categorical variables from 2000-2023 patient data.
- Utilized random effects models and meta-analysis of proportions with logit transformations.
- Extracted demographic, periprocedural, and postoperative clinical data.
Main Results:
- Child-Pugh class A (60%), B (33%), and C (4%) were observed.
- Postoperative renal failure occurred in 30% of patients; in-patient mortality was 11%.
- Significant association found between Child-Pugh classification and 3-year postoperative survival; no significant MELD score relationship observed.
Conclusions:
- Preoperative Child-Pugh classification is a significant predictor of postoperative clinical outcomes in cardiac surgery patients with cirrhosis.
- Further research with more granular data is needed to clarify the association between MELD scores and outcomes in this specific patient group.
Abstract:
Cirrhosis is a progressive form of liver disease associated with significant patient morbidity and mortality. Model for End-Stage Liver Disease (MELD) and Child-Pugh scores are disease severity classification systems that carry predictive value for patients undergoing various procedures. Missing is a granular analysis exploring the association between liver disease severity and clinical outcomes among patients who require cardiac surgery. Our study extracted demographic, periprocedural, and postoperative clinical data for patients with liver cirrhosis undergoing cardiac surgery between 2000 and 2023. Continuous variables were pooled by meta-analysis utilizing a random effects model, and categorical variables were studied using meta-analysis of proportions with logit transformations. The most frequently observed Child-Pugh classification was class A in 60% of patients (95% confidence interval [CI]: 53-67), followed by class B in 33% (95% CI: 27-39) and class C in 4% (95% CI: 2-6). Notably, 30% of patients developed renal failure in the postoperative period (95% CI: 21-39), and overall in-patient mortality occurred in 11% of patients (95% CI: 9-14). There was a significant association between Child-Pugh classification and overall patient survival for 3 years in the postoperative period. No significant relationship was observed between preoperative MELD score and postoperative clinical outcomes. Preoperative Child-Pugh classification is associated with postoperative clinical outcomes among patients undergoing cardiac surgery. More granular data are required to understand the association between MELD scores and postoperative outcomes within the cardiac surgery population.
