Teh Swee H, Nagorney David M, Stevens Susanna R, Offord Kenneth P, Therneau Terry M, Plevak David J, Talwalkar Jayant A, Kim W Ray, Kamath Patrick S
Division of Gastroenterologic and General Surgery, Mayo Clinic, Rochester, Minnesota, USA.
Gastroenterology. 2007 Apr;132(4):1261-9. doi: 10.1053/j.gastro.2007.01.040. Epub 2007 Jan 25.
BACKGROUND & AIMS: Current methods of predicting risk of postoperative mortality in patients with cirrhosis are suboptimal. The utility of the Model for End-stage Liver Disease (MELD) in predicting mortality after surgery other than liver transplantation is unknown. The aim of this study was to determine the risk factors for postoperative mortality in patients with cirrhosis.
Patients with cirrhosis (N = 772) who underwent major digestive (n = 586), orthopedic (n = 107), or cardiovascular (n = 79) surgery were studied. Control groups of patients with cirrhosis included 303 undergoing minor surgical procedures and 562 ambulatory patients. Univariate and multivariable proportional hazards analyses were used to determine the relationship between risk factors and mortality.
Patients undergoing major surgery were at increased risk for mortality up to 90 days postoperatively. By multivariable analysis, only MELD score, American Society of Anesthesiologists class, and age predicted mortality at 30 and 90 days, 1 year, and long-term, independently of type or year of surgery. Emergency surgery was the only independent predictor of duration of hospitalization postoperatively. Thirty-day mortality ranged from 5.7% (MELD score, <8) to more than 50% (MELD score, >20). The relationship between MELD score and mortality persisted throughout the 20-year postoperative period.
MELD score, age, and American Society of Anesthesiologists class can quantify the risk of mortality postoperatively in patients with cirrhosis, independently of the procedure performed. These factors can be used in determining operative mortality risk and whether elective surgical procedures can be delayed until after liver transplantation.
目前预测肝硬化患者术后死亡风险的方法并不理想。终末期肝病模型（MELD）在预测肝移植以外的手术死亡率方面的效用尚不清楚。本研究的目的是确定肝硬化患者术后死亡的危险因素。
对772例肝硬化患者进行了研究，这些患者接受了大型消化手术（n = 586）、骨科手术（n = 107）或心血管手术（n = 79）。肝硬化患者的对照组包括303例接受小手术的患者和562例门诊患者。采用单因素和多因素比例风险分析来确定危险因素与死亡率之间的关系。
接受大型手术的患者术后90天内死亡风险增加。通过多因素分析，只有MELD评分、美国麻醉医师协会分级和年龄能独立于手术类型或年份预测术后30天和90天、1年及长期的死亡率。急诊手术是术后住院时间的唯一独立预测因素。30天死亡率从5.7%（MELD评分<8）到超过50%（MELD评分>20）不等。MELD评分与死亡率之间的关系在术后20年期间一直存在。
MELD评分、年龄和美国麻醉医师协会分级可以独立于所进行的手术来量化肝硬化患者术后的死亡风险。这些因素可用于确定手术死亡风险以及择期手术是否可以推迟到肝移植之后进行。
