Lin Cheng-Hsin, Hsu Ron-Bin
Cheng-Hsin Lin, Ron-Bin Hsu, Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei 100, Taiwan.
World J Gastroenterol. 2014 Sep 21;20(35):12608-14. doi: 10.3748/wjg.v20.i35.12608.
To evaluate the results of cardiac surgery in cirrhotic patients and to find the predictors of early and late mortality.
We included 55 consecutive cirrhotic patients undergoing cardiac surgery between 1993 and 2012. Child-Turcotte-Pugh (Child) classification and Model for End-Stage Liver Disease (MELD) score were used to assess the severity of liver cirrhosis. The online EuroSCORE II calculator was used to calculate the logistic EuroSCORE in each patient. Stepwise logistic regression analysis was used to identify the risk factors for mortality at different times after surgery. Multivariate Cox proportional hazard models were applied to estimate the hazard ratios (HR) of predictors for mortality. The Kaplan-Meier method was used to generate survival curves, and the survival rates between groups were compared using the log-rank test.
There were 30 patients in Child class A, 20 in Child B, and five in Child C. The hospital mortality rate was 16.4%. The actuarial survival rates were 70%, 64%, 56%, and 44% at 1, 2, 3, and 5 years after surgery, respectively. There were no significant differences in major postoperative complications, and early and late mortality between patients with mild and advanced cirrhosis. Multivariate logistic regression showed preoperative serum bilirubin, the EuroSCORE and coronary artery bypass grafting (CABG) were associated with early and late mortality; however, Child class and MELD score were not. Cox regression analysis identified male gender (HR = 0.319; P = 0.009), preoperative serum bilirubin (HR = 1.244; P = 0.044), the EuroSCORE (HR = 1.415; P = 0.001), and CABG (HR = 3.344; P = 0.01) as independent risk factors for overall mortality.
Advanced liver cirrhosis should not preclude patients from cardiac surgery. Preoperative serum bilirubin, the EuroSCORE, and CABG are major predictors of early and late mortality.
评估肝硬化患者心脏手术的结果，并找出早期和晚期死亡的预测因素。
我们纳入了1993年至2012年间连续接受心脏手术的55例肝硬化患者。采用Child-Turcotte-Pugh（Child）分级和终末期肝病模型（MELD）评分来评估肝硬化的严重程度。使用在线EuroSCORE II计算器计算每位患者的逻辑EuroSCORE。采用逐步逻辑回归分析确定术后不同时间死亡率的危险因素。应用多变量Cox比例风险模型估计死亡率预测因素的风险比（HR）。采用Kaplan-Meier法生成生存曲线，并使用对数秩检验比较各组之间的生存率。
Child A级患者30例，Child B级患者20例，Child C级患者5例。医院死亡率为16.4%。术后1年、2年、3年和5年的精算生存率分别为70%、64%、56%和44%。轻度和重度肝硬化患者术后主要并发症、早期和晚期死亡率无显著差异。多变量逻辑回归显示术前血清胆红素、EuroSCORE和冠状动脉旁路移植术（CABG）与早期和晚期死亡率相关；然而，Child分级和MELD评分与死亡率无关。Cox回归分析确定男性（HR = 0.319；P = 0.009）、术前血清胆红素（HR = 1.244；P = 0.044）、EuroSCORE（HR = 1.415；P = 0.001）和CABG（HR = 3.344；P = 0.01）是总体死亡率的独立危险因素。
晚期肝硬化不应成为患者接受心脏手术的禁忌。术前血清胆红素、EuroSCORE和CABG是早期和晚期死亡的主要预测因素。
