Department of Surgery, University of Virginia, Charlottesville, VA, USA; Surgical Outcomes Research Center, University of Virginia, Charlottesville, VA, USA; Section of Hepatobiliary and Pancreatic Surgery, University of Virginia, Charlottesville, VA, USA.
Department of Surgery, University of Virginia, Charlottesville, VA, USA; Surgical Outcomes Research Center, University of Virginia, Charlottesville, VA, USA.
Am J Surg. 2020 Sep;220(3):682-686. doi: 10.1016/j.amjsurg.2020.01.022. Epub 2020 Jan 20.
Independent associations between chronic liver disease, MELD, and postoperative outcomes among patients selected for liver resection have not been completely established. We hypothesized independent associations between MELD, cirrhosis, and postoperative mortality.
Patient-level data from the targeted hepatectomy module and ACS NSQIP PUF during 2014-2015 were merged. Multivariable regression models with interaction effect between MELD and liver texture (normal, congested/fatty, cirrhotic) tested the independent effects of covariates on mortality and morbidity.
3,530 patients were included, of whom 668 patients (19%) had cirrhosis. ACS NSQIP defined mortality (3.9%vs1.1%) and morbidity (23.5%vs15.8%) were higher in patients with cirrhosis (both p < 0.001). In multivariable models, cirrhosis (OR = 2.24; 95%CI:1.16-4.34, p = 0.016) and MELD (OR = 1.10; 95%CI:1.03-1.18, p = 0.007) were independently associated with mortality. MELD (OR = 1.04; 95%CI:1.002-1.08, p = 0.038) was associated with postoperative morbidity.
Higher MELD and presence of cirrhosis have an independent negative effect on mortality after liver resection. MELD could be used to estimate postoperative risk in patients with and without cirrhosis.
慢性肝病、MELD 评分和肝切除术患者术后结局之间的独立关联尚未完全确定。我们假设 MELD、肝硬化与术后死亡率之间存在独立关联。
合并了 2014-2015 年靶向肝切除术模块和 ACS NSQIP PUF 的患者水平数据。多变量回归模型中，MELD 与肝脏质地（正常、充血/脂肪、肝硬化）之间存在交互效应，用于测试协变量对死亡率和发病率的独立影响。
共纳入 3530 例患者，其中 668 例（19%）患有肝硬化。ACS NSQIP 定义的死亡率（3.9%比 1.1%）和发病率（23.5%比 15.8%）在肝硬化患者中更高（均 p<0.001）。多变量模型中，肝硬化（OR=2.24；95%CI：1.16-4.34，p=0.016）和 MELD（OR=1.10；95%CI：1.03-1.18，p=0.007）与死亡率独立相关。MELD（OR=1.04；95%CI：1.002-1.08，p=0.038）与术后发病率相关。
较高的 MELD 和肝硬化的存在对肝切除术后的死亡率有独立的负面影响。MELD 可用于估计有无肝硬化患者的术后风险。
