Simplified model for end-stage liver disease score predicts mortality for tricuspid valve surgery

• Published in: Interactive cardiovascular and thoracic surgery 2013-05, Vol.16 (5), p.630-635
• Main Authors: Tsuda, Kazumasa, Koide, Masaaki, Kunii, Yoshifumi, Watanabe, Kazumasa, Miyairi, Satoshi, Ohashi, Yuko, Harada, Takashi
• Format: Article
• Language: English
• Subjects: Aged; Bilirubin - blood; Biomarkers - blood; Blood Coagulation - drug effects; Comorbidity; Creatinine - blood; Female; Heart Valve Diseases - blood; Heart Valve Diseases - mortality; Heart Valve Diseases - surgery; Heart Valve Prosthesis Implantation - adverse effects; Heart Valve Prosthesis Implantation - mortality; Hospital Mortality; Humans; International Normalized Ratio; Japan; Liver Diseases - blood; Liver Diseases - diagnosis; Liver Diseases - mortality; Logistic Models; Male; Middle Aged; Multivariate Analysis; Odds Ratio; Retrospective Studies; Risk Assessment; Risk Factors; Severity of Illness Index; Time Factors; Treatment Outcome; Tricuspid Valve - surgery; Warfarin - therapeutic use
• ISSN: 1569-9293; 1569-9285
• DOI: 10.1093/icvts/ivt014

OBJECTIVES The model for end-stage liver disease score (MELD = 3.8*LN[total bilirubin] + 9.6*LN[creatinine] + 11.2*[PT-INR] + 6.4) predicts mortality for tricuspid valve surgery. However, the MELD is problematic in patients undergoing warfarin therapy, as warfarin affects the international normalized ratio (INR). This study aimed to determine whether a simplified MELD score that does not require the INR for calculation could predict mortality for patients undergoing tricuspid valve surgery. Simplified MELD METHODS A total of 172 patients (male: 66, female: 106; mean age, 63.8 ± 10.3 years) who underwent tricuspid replacement (n = 18) or repair (n = 154) from January 1991 to July 2011 at a single centre were included. Of them, 168 patients in whom the simplified MELD score could be calculated were retrospectively analysed. The relationship between in-hospital mortality and perioperative variables was assessed by univariate and multivariate analysis. RESULTS The rate of in-hospital mortality was 6.4%. The mean admission simplified MELD score for the patients who died was significantly higher than for those surviving beyond discharge (11.3 ± 4.1 vs 5.8 ± 4.0; P = 0.001). By multivariate analysis, independent risk factors for in-hospital mortality included higher simplified MELD score (P = 0.001) and tricuspid valve replacement (P = 0.023). In-hospital mortality and morbidity increased along with increasing simplified MELD score. Scores 14 were associated with mortalities of 0, 2.0, 8.3 and 66.7%, respectively. The incidence of serious complications (multiple organ failure, P = 0.005; prolonged ventilation, P = 0.01; need for haemodialysis; P = 0.002) was also significantly higher in patients with simplified MELD score ≥7. CONCLUSIONS The simplified MELD score predicts mortality in patients undergoing tricuspid valve surgery. This model requires only total bilirubin and creatinine and is therefore applicable in patients undergoing warfarin therapy.