The Utility of the MELD Score in Predicting Mortality Following Liver Resection for Metastasis

Abstract BACKGROUND The MELD score has been demonstrated to be predictive of hepatectomy outcomes in mixed patient samples of primary and secondary liver cancers. Because MELD is a measure of hepatic dysfunction, prior conclusions may rely on the high prevalence of cirrhosis observed with primary le...

Full description

Saved in:
Bibliographic Details
Published in:European journal of surgical oncology 2016-10, Vol.42 (10), p.1568-1575
Main Authors: Fromer, Marc W., M.D, Aloia, Thomas A., M.D, Gaughan, John P., M.S., Ph.D., M.B.A, Atabek, Umur M., M.D, Spitz, Francis R., M.D, FACS
Format: Article
Language:English
Subjects:
Aged
Creatinine - blood
Female
Hematology, Oncology and Palliative Medicine
Hepatectomy
Hepatectomy - mortality
Humans
Liver Neoplasms - secondary
Liver Neoplasms - surgery
Liver resection
Male
MELD score
Metastasectomy - mortality
Metastasis
Middle Aged
Model for end-stage liver disease
Mortality complication
Severity of Illness Index
Surgery
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Abstract BACKGROUND The MELD score has been demonstrated to be predictive of hepatectomy outcomes in mixed patient samples of primary and secondary liver cancers. Because MELD is a measure of hepatic dysfunction, prior conclusions may rely on the high prevalence of cirrhosis observed with primary lesions. This study aims to evaluate MELD score as a predictor of mortality and develop a risk prediction model for patients specifically undergoing hepatic metastasectomy. METHODS ACS-NSQIP 2005-2013 was analyzed to select patients who had undergone liver resections for metastases. A receiver operating characteristic (ROC) analysis determined the MELD score most associated with 30-day mortality. A literature review identified variables that impact hepatectomy outcomes. Significant factors were included in a multivariable analysis (MVA). A risk calculator was derived from the final multivariable model. RESULTS Among the 14919 patients assessed, the mortality rate was 2.7%, and the median MELD was 7.3 (range=34.4). A MELD of 7.24 was identified by ROC (sensitivity=81%, specificity=51%, c-statistic=0.71). Of all patients above this threshold, 4.4% died at 30 days, vs. 1.1% in the group < 7.24. This faction represented 50.1% of the population but accounted for 80.3% of all deaths (p
ISSN:0748-7983
1532-2157
DOI:10.1016/j.ejso.2016.05.035