Schroeder Rebecca A, Marroquin Carlos E, Bute Barbara Phillips, Khuri Shukri, Henderson William G, Kuo Paul C
Department of Anesthesiology, Durham Veterans Medical Center, Duke University School of Medicine, Durham, NC 27705, USA.
Ann Surg. 2006 Mar;243(3):373-9. doi: 10.1097/01.sla.0000201483.95911.08.
To determine if use of Model for End-Stage Liver Disease (MELD) scores to elective resections accurately predicts short-term morbidity or mortality.
MELD scores have been validated in the setting of end-stage liver disease for patients awaiting transplantation or undergoing transvenous intrahepatic portosystemic shunt procedures. Its use in predicting outcomes after elective hepatic resection has not been evaluated.
Records of 587 patients who underwent elective hepatic resection and were included in the National Surgical Quality Improvement Program Database were reviewed. MELD score, CTP score, Charlson Index of Comorbidity, American Society of Anesthesiology classification, and age were evaluated for their ability to predict short-term morbidity and mortality. Morbidity was defined as the development of one or more of the following complications: pulmonary edema or embolism, myocardial infarction, stroke, renal failure or insufficiency, pneumonia, deep venous thrombosis, bleeding, deep wound infection, reoperation, or hyperbilirubinemia. The analysis was repeated with patients divided according to their procedure and their primary diagnosis. Parametric or nonparametric analyses were performed as appropriate. Also, a new index was developed by dividing the patients into a development and a validation cohort, to predict morbidity and mortality in patients undergoing elective hepatic resection. ROC curves were also constructed for each of the primary indices.
CTP and ASA scores were superior in predicting outcome. Also, patients undergoing resection of primary malignancies had a higher rate of mortality but no difference in morbidity.
MELD scores should not be used to predict outcomes in the setting of elective hepatic resection.
确定使用终末期肝病模型（MELD）评分来评估择期肝切除术是否能准确预测短期发病率或死亡率。
MELD评分已在终末期肝病患者等待肝移植或接受经颈静脉肝内门体分流术的情况下得到验证。其在预测择期肝切除术后结局方面的应用尚未得到评估。
回顾了纳入国家外科质量改进计划数据库的587例行择期肝切除术患者的记录。评估MELD评分、Child-Turcotte-Pugh（CTP）评分、查尔森合并症指数、美国麻醉医师协会分级和年龄预测短期发病率和死亡率的能力。发病率定义为出现以下一种或多种并发症：肺水肿或肺栓塞、心肌梗死、中风、肾衰竭或肾功能不全、肺炎、深静脉血栓形成、出血、深部伤口感染、再次手术或高胆红素血症。根据手术方式和主要诊断对患者进行分组后重复该分析。酌情进行参数或非参数分析。此外，通过将患者分为一个开发队列和一个验证队列，开发了一种新的指数，以预测择期肝切除术患者的发病率和死亡率。还为每个主要指标构建了ROC曲线。
CTP评分和美国麻醉医师协会分级在预测结局方面更具优势。此外，接受原发性恶性肿瘤切除术的患者死亡率较高，但发病率无差异。
MELD评分不应被用于预测择期肝切除术的结局。
