M.E.L.D. in surgical risk evaluation of cirrhotic patients - Preliminary analysis of 98 cases - M.E.L.D. in surgical risk evaluation
Autor(a) principal: | |
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Data de Publicação: | 2008 |
Outros Autores: | , , , |
Tipo de documento: | Artigo |
Idioma: | por |
Título da fonte: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Texto Completo: | https://revista.spcir.com/index.php/spcir/article/view/252 |
Resumo: | Introduction: Hepatic cirrhosis is a recognized surgical risk factor. Recent studies suggested that M.E.L.D. (Model for End-Stage Liver Disease) may represent a promising alternative to Child-Turcotte-Pugh classification as a predictive factor of operative mortality and morbidity; incorporation of serum sodium and age (iM.E.L.D.) seems to improve its prognostic potential. Objectives: To evaluate the utility of M.E.L.D. and iM.E.L.D. in the quantification of surgical risk of cirrhotic patients and to compare its prognostic value with the Child-Turcotte-Pugh classification. Material and methods: A retrospective study of 98 cirrhotic patients operated, in our department, between 1998 and 2007 was undertaken. Results: Forty nine per cent of the patients were included in A class of Child-Turcotte-Pugh; mean M.E.L.D. score was 7,5±2,6 (1,6- 15,2) and mean iM.E.L.D. score was 31,5±6,1 (16,8-46,3). Mortality and morbidity rates were 11% and 29%, respectively. iM.E.L.D. represented a significant prognostic factor of mortality (auR.O.C.=82%, 70,7-94,1; p=0,001) with a better predictive potential than M.E.L.D. (auR.O.C.=66%, 46,6-85,5; p=0,048) and Child-Turcotte-Pugh classification (auR.O.C.=62%, 40-84,5; p=0,037). iM.E.L.D. score was superior in cases of mortality (37,7±5,6 versus 30,5±5,6; p=0,0001); the operative death probability was 3,6% (2,9- 4,4) in patients with a score inferior or equal to 31, 16% (13-19) between 32 e 38 and 49,5% (37,9-61,7) when superior or equal to 39. M.E.L.D. was related with mortality as a discontinuous variable: score superior or equal to 12 were associated with a mortality rate of 50% (versus 8,8%; p=0,002; odds ratio=7,4; IC 95% 2,8-19,2), with a better accuracy than Child-Turcotte-Pugh classification (89,7 versus 85,6%). Conclusions: In this study, iM.E.L.D. and M.E.L.D. scores (that one used for the first time in the perioperative context) revealed to be excellent predictive parameters of operative mortality and morbidity in cirrhotic patients, with good correlation and accuracy superior to Child-Turcotte-Pugh classification; they also showed better discriminative capacity, objectivity and reproducibility. And if our results are confirmed in further studies, they will have a major interest in surgical risk evaluation of patients with chronic hepatic diseases. Keywords: Surgical risk, cirrhosis, Meld, iMeld, Child-Turcotte-Pugh |
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M.E.L.D. in surgical risk evaluation of cirrhotic patients - Preliminary analysis of 98 cases - M.E.L.D. in surgical risk evaluationImportância do M.E.L.D. na avaliação do risco cirúrgico de doentes cirróticos - Análise preliminar de 98 casos - O M.E.L.D. na avaliação do risco cirúrgicoIntroduction: Hepatic cirrhosis is a recognized surgical risk factor. Recent studies suggested that M.E.L.D. (Model for End-Stage Liver Disease) may represent a promising alternative to Child-Turcotte-Pugh classification as a predictive factor of operative mortality and morbidity; incorporation of serum sodium and age (iM.E.L.D.) seems to improve its prognostic potential. Objectives: To evaluate the utility of M.E.L.D. and iM.E.L.D. in the quantification of surgical risk of cirrhotic patients and to compare its prognostic value with the Child-Turcotte-Pugh classification. Material and methods: A retrospective study of 98 cirrhotic patients operated, in our department, between 1998 and 2007 was undertaken. Results: Forty nine per cent of the patients were included in A class of Child-Turcotte-Pugh; mean M.E.L.D. score was 7,5±2,6 (1,6- 15,2) and mean iM.E.L.D. score was 31,5±6,1 (16,8-46,3). Mortality and morbidity rates were 11% and 29%, respectively. iM.E.L.D. represented a significant prognostic factor of mortality (auR.O.C.=82%, 70,7-94,1; p=0,001) with a better predictive potential than M.E.L.D. (auR.O.C.=66%, 46,6-85,5; p=0,048) and Child-Turcotte-Pugh classification (auR.O.C.=62%, 40-84,5; p=0,037). iM.E.L.D. score was superior in cases of mortality (37,7±5,6 versus 30,5±5,6; p=0,0001); the operative death probability was 3,6% (2,9- 4,4) in patients with a score inferior or equal to 31, 16% (13-19) between 32 e 38 and 49,5% (37,9-61,7) when superior or equal to 39. M.E.L.D. was related with mortality as a discontinuous variable: score superior or equal to 12 were associated with a mortality rate of 50% (versus 8,8%; p=0,002; odds ratio=7,4; IC 95% 2,8-19,2), with a better accuracy than Child-Turcotte-Pugh classification (89,7 versus 85,6%). Conclusions: In this study, iM.E.L.D. and M.E.L.D. scores (that one used for the first time in the perioperative context) revealed to be excellent predictive parameters of operative mortality and morbidity in cirrhotic patients, with good correlation and accuracy superior to Child-Turcotte-Pugh classification; they also showed better discriminative capacity, objectivity and reproducibility. And if our results are confirmed in further studies, they will have a major interest in surgical risk evaluation of patients with chronic hepatic diseases. Keywords: Surgical risk, cirrhosis, Meld, iMeld, Child-Turcotte-Pugh Introdução: A cirrose hepática constitui um conhecido factor de risco cirúrgico cuja quantificação é fundamental na avaliação pré-operatória. Estudos recentes sugerem que o M.E.L.D. (Model for End-Stage Liver Disease) pode constituir uma alternativa promissora à classificação de Child-Turcotte-Pugh como factor preditivo de mortalidade e morbilidade operatórias; a incorporação da natrémia e da idade (iM.E.L.D.) parece melhorar, ainda, a sua capacidade prognóstica. Objectivos: Avaliar a importância do M.E.L.D. e do iM.E.L.D. na quantificação do risco cirúrgico de doentes cirróticos e comparar o seu valor prognóstico com o da classificação de Child-Turcotte-Pugh. Material e métodos: Estudo retrospectivo de 98 doentes cirróticos operados, no nosso serviço, entre 1998 e 2007. Resultados: Quarenta e nove por centro dos doentes pertenciam à Classe A da classificação de Child-Turcotte-Pugh; os valores médios do M.E.L.D. foram de 7,5±2,6 (1,6-15,2) e os do iM.E.L.D. de 31,5±6,1 (16,8-46,3). As taxas de mortalidade e morbilidade operatórias foram de 11% e 29%, respectivamente. O iM.E.L.D. constituiu um significativo factor prognóstico de mortalidade (aaR.O.C.=82%, 70,7-94,1; p=0,001), com potencial preditivo superior ao M.E.L.D. (aaR.O.C.=66%, 46,6-85,5; p=0,048) e à classificação de Child-Turcotte-Pugh (aaR.O.C.=62%, 40-84,5; p=0,037). O iM.E.L.D. foi mais elevado nos casos de mortalidade (37,7±5,6 versus 30,5±5,6; p=0,0001); a probabilidade de morte operatória foi de 3,6% (2,9-4,4) para valores inferiores ou iguais a 31, de 16% (13-19) entre 32 e 38 e 49,5% (37,9-61,7) quando superiores ou iguais a 39. O M.E.L.D. relacionou-se com a mortalidade como variável descontínua: valores superiores ou iguais a 12 associaram-se a uma taxa de mortalidade de 50% (versus 8,8%; p=0,002; odds ratio=7,4; IC 95% 2,8-19,2), com uma acuidade superior á da Classificação de Child-Turcotte-Pugh (89,7 versus 85,6%). Conclusões: Nesta série, o M.E.L.D. e o iM.E.L.D. (este utilizado pela primeira vez no contexto peri-operatório) revelaram-se factores preditivos de mortalidade e morbilidade operatórias em doentes cirróticos, com boa correlação e acuidade superior à clássica classificação de Child-Turcotte-Pugh; demonstraram, também, maiores capacidade discriminativa, objectividade e reprodutibilidade. Pelo que, a confirmarem-se os resultados deste estudo, virão a representar parâmetros com interesse particularmente relevante na avaliação do risco cirúrgico dos pacientes portadores de hepatopatias crónicas. Palavras-chave: Risco cirúrgico, cirrose, Meld, iMeld, Child-Turcotte-Pugh Sociedade Portuguesa de Cirurgia2008-06-28info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttps://revista.spcir.com/index.php/spcir/article/view/252Revista Portuguesa de Cirurgia; No 5 (2008): Junho 2008 - II Série; 7-18Revista Portuguesa de Cirurgia; No 5 (2008): Junho 2008 - II Série; 7-182183-11651646-6918reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAPporhttps://revista.spcir.com/index.php/spcir/article/view/252https://revista.spcir.com/index.php/spcir/article/view/252/251Copyright (c) 2016 Revista Portuguesa de Cirurgiainfo:eu-repo/semantics/openAccessCosta, Beatriz Pinto daSousa, Francisco CastroCarvalho, CésarSerôdio, MarcoMoeria, Joana2024-03-14T22:05:19Zoai:revista.spcir.com:article/252Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-20T04:00:52.762176Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse |
dc.title.none.fl_str_mv |
M.E.L.D. in surgical risk evaluation of cirrhotic patients - Preliminary analysis of 98 cases - M.E.L.D. in surgical risk evaluation Importância do M.E.L.D. na avaliação do risco cirúrgico de doentes cirróticos - Análise preliminar de 98 casos - O M.E.L.D. na avaliação do risco cirúrgico |
title |
M.E.L.D. in surgical risk evaluation of cirrhotic patients - Preliminary analysis of 98 cases - M.E.L.D. in surgical risk evaluation |
spellingShingle |
M.E.L.D. in surgical risk evaluation of cirrhotic patients - Preliminary analysis of 98 cases - M.E.L.D. in surgical risk evaluation Costa, Beatriz Pinto da |
title_short |
M.E.L.D. in surgical risk evaluation of cirrhotic patients - Preliminary analysis of 98 cases - M.E.L.D. in surgical risk evaluation |
title_full |
M.E.L.D. in surgical risk evaluation of cirrhotic patients - Preliminary analysis of 98 cases - M.E.L.D. in surgical risk evaluation |
title_fullStr |
M.E.L.D. in surgical risk evaluation of cirrhotic patients - Preliminary analysis of 98 cases - M.E.L.D. in surgical risk evaluation |
title_full_unstemmed |
M.E.L.D. in surgical risk evaluation of cirrhotic patients - Preliminary analysis of 98 cases - M.E.L.D. in surgical risk evaluation |
title_sort |
M.E.L.D. in surgical risk evaluation of cirrhotic patients - Preliminary analysis of 98 cases - M.E.L.D. in surgical risk evaluation |
author |
Costa, Beatriz Pinto da |
author_facet |
Costa, Beatriz Pinto da Sousa, Francisco Castro Carvalho, César Serôdio, Marco Moeria, Joana |
author_role |
author |
author2 |
Sousa, Francisco Castro Carvalho, César Serôdio, Marco Moeria, Joana |
author2_role |
author author author author |
dc.contributor.author.fl_str_mv |
Costa, Beatriz Pinto da Sousa, Francisco Castro Carvalho, César Serôdio, Marco Moeria, Joana |
description |
Introduction: Hepatic cirrhosis is a recognized surgical risk factor. Recent studies suggested that M.E.L.D. (Model for End-Stage Liver Disease) may represent a promising alternative to Child-Turcotte-Pugh classification as a predictive factor of operative mortality and morbidity; incorporation of serum sodium and age (iM.E.L.D.) seems to improve its prognostic potential. Objectives: To evaluate the utility of M.E.L.D. and iM.E.L.D. in the quantification of surgical risk of cirrhotic patients and to compare its prognostic value with the Child-Turcotte-Pugh classification. Material and methods: A retrospective study of 98 cirrhotic patients operated, in our department, between 1998 and 2007 was undertaken. Results: Forty nine per cent of the patients were included in A class of Child-Turcotte-Pugh; mean M.E.L.D. score was 7,5±2,6 (1,6- 15,2) and mean iM.E.L.D. score was 31,5±6,1 (16,8-46,3). Mortality and morbidity rates were 11% and 29%, respectively. iM.E.L.D. represented a significant prognostic factor of mortality (auR.O.C.=82%, 70,7-94,1; p=0,001) with a better predictive potential than M.E.L.D. (auR.O.C.=66%, 46,6-85,5; p=0,048) and Child-Turcotte-Pugh classification (auR.O.C.=62%, 40-84,5; p=0,037). iM.E.L.D. score was superior in cases of mortality (37,7±5,6 versus 30,5±5,6; p=0,0001); the operative death probability was 3,6% (2,9- 4,4) in patients with a score inferior or equal to 31, 16% (13-19) between 32 e 38 and 49,5% (37,9-61,7) when superior or equal to 39. M.E.L.D. was related with mortality as a discontinuous variable: score superior or equal to 12 were associated with a mortality rate of 50% (versus 8,8%; p=0,002; odds ratio=7,4; IC 95% 2,8-19,2), with a better accuracy than Child-Turcotte-Pugh classification (89,7 versus 85,6%). Conclusions: In this study, iM.E.L.D. and M.E.L.D. scores (that one used for the first time in the perioperative context) revealed to be excellent predictive parameters of operative mortality and morbidity in cirrhotic patients, with good correlation and accuracy superior to Child-Turcotte-Pugh classification; they also showed better discriminative capacity, objectivity and reproducibility. And if our results are confirmed in further studies, they will have a major interest in surgical risk evaluation of patients with chronic hepatic diseases. Keywords: Surgical risk, cirrhosis, Meld, iMeld, Child-Turcotte-Pugh |
publishDate |
2008 |
dc.date.none.fl_str_mv |
2008-06-28 |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
https://revista.spcir.com/index.php/spcir/article/view/252 |
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https://revista.spcir.com/index.php/spcir/article/view/252 |
dc.language.iso.fl_str_mv |
por |
language |
por |
dc.relation.none.fl_str_mv |
https://revista.spcir.com/index.php/spcir/article/view/252 https://revista.spcir.com/index.php/spcir/article/view/252/251 |
dc.rights.driver.fl_str_mv |
Copyright (c) 2016 Revista Portuguesa de Cirurgia info:eu-repo/semantics/openAccess |
rights_invalid_str_mv |
Copyright (c) 2016 Revista Portuguesa de Cirurgia |
eu_rights_str_mv |
openAccess |
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application/pdf |
dc.publisher.none.fl_str_mv |
Sociedade Portuguesa de Cirurgia |
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Sociedade Portuguesa de Cirurgia |
dc.source.none.fl_str_mv |
Revista Portuguesa de Cirurgia; No 5 (2008): Junho 2008 - II Série; 7-18 Revista Portuguesa de Cirurgia; No 5 (2008): Junho 2008 - II Série; 7-18 2183-1165 1646-6918 reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação instacron:RCAAP |
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Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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RCAAP |
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RCAAP |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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