Circulation
Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI 48109-5853, USA.
Published: January 2010
Background: The Model for End-Stage Liver Disease (MELD) predicts events in cirrhotic subjects undergoing major surgery and may offer similar prognostication in left ventricular assist device candidates with comparable degrees of multisystem dysfunction.
Methods And Results: Preoperative MELD scores were calculated for subjects enrolled in the University of Michigan Health System (UMHS) mechanical circulatory support database. Univariate and multiple regression analyses were performed to investigate the ability of patient characteristics, laboratory data (including MELD scores), and hemodynamic measurements to predict total perioperative blood product exposure and operative mortality. The ability of preoperative MELD scores to predict operative mortality was evaluated in subjects enrolled in the Interagency Registry of Mechanically Assisted Circulatory Support (INTERMACS), and results were compared with those from the UMHS cohort. The mean+/-SD MELD scores for the UMHS (n=211) and INTERMACS (n=324) cohorts were 13.7+/-6.1 and 15.2+/-5.8, respectively, with 29 (14%) and 19 (6%) perioperative deaths. In the UMHS cohort, median total perioperative blood product exposure was 74 units (25th and 75th percentiles, 44 and 120 units). Each 5-unit MELD score increase was associated with 15.1+/-3.8 units (beta+/-SE) of total perioperative blood product exposure. Each 10-unit increase in total perioperative blood product exposure increased the odds of operative death (odds ratio, 1.05; 95% confidence interval, 1.01 to 1.10). Odds ratios, measuring the ability of MELD scores to predict perioperative mortality, were 1.5 (95% confidence interval, 1.1 to 2.0) and 1.5 (95% confidence interval, 1.1 to 2.1) per 5 MELD units for the UMHS and INTERMACS cohorts, respectively. When MELD scores were dichotomized as >or=17 and <17, risk-adjusted Cox proportional-hazard ratios for 6-month mortality were 2.5 (95% confidence interval, 1.2 to 5.3) and 2.5 (95% confidence interval, 1.1 to 5.4) for the UMHS and INTERMACS cohorts, respectively.
Conclusions: The MELD score identified left ventricular assist device candidates at high risk for perioperative bleeding and mortality.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2824259 | PMC |
http://dx.doi.org/10.1161/CIRCULATIONAHA.108.838656 | DOI Listing |
Cureus
December 2024
Medicine/Cardiology, Rutgers University New Jersey Medical School, Newark, USA.
Coronary artery disease (CAD) is associated with poor outcomes after orthotopic liver transplantation (OLT). We report on six high-risk end-stage liver disease (ESLD) patients who underwent percutaneous coronary intervention (PCI) with bare metal stents during the preoperative evaluation process. There was no mortality or major adverse cardiac event (MACE) within 90 days of OLT.
View Article and Find Full Text PDFMed J Armed Forces India
April 2024
Senior Advisor (Medicine) & Gastroenterologist, Command Hospital (Southern Command), Pune, India.
Background: Acute-on-chronic liver failure (ACLF) is a life threatening disease. This study seeks to identify factors that contribute to greater financial burden in ACLF.
Methods: In total, 55 patients were included.
World J Hepatol
January 2025
Faculty of Medicine, Mansoura University, Mansoura 35511, Egypt.
Background: Chronic liver disease is a growing global health problem, leading to hepatic decompensation characterized by an array of clinical and biochemical complications. Several scoring systems have been introduced in assessing the severity of hepatic decompensation with the most frequent ones are Child-Pugh score, model of end-stage liver disease (MELD) score, and MELD-Na score. Anemia is frequently observed in cirrhotic patients and is linked to worsened clinical outcomes.
View Article and Find Full Text PDFClin Transplant
February 2025
Division of Transplantation Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA.
Introduction: Hepatic epithelioid hemangioendothelioma (HEH) is a rare indication of liver transplant with limited evidence.
Methods: Adult recipients undergoing first-time liver-only transplant from 2002 to 2021 in the United States were identified using the UNOS/OPTN database. We compared post-transplant outcomes of recipients receiving liver transplant for HEH versus other diagnoses.
Front Cell Infect Microbiol
January 2025
Department of Gastroenterology, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, China.
Background And Aims: The impact of coronavirus disease 2019 (COVID-19) on patients with acute-on-chronic liver failure (ACLF) remains unclear. To investigate the clinical characteristics of patients with ACLF complicated with COVID-19 in order to provide evidence for the precise treatment of this patient population.
Methods: A total of 34 ACLF patients with COVID-19 admitted to these three hospitals from December 2022 to August 2023 were included as the ACLF+COVID-19 group.
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