终末期肝病模型钠作为腹水肝硬化患者手术风险的预测因子。

Model for End-Stage Liver Disease Sodium as a Predictor of Surgical Risk in Cirrhotic Patients With Ascites.

机构信息

Department of Surgery, Yale School of Medicine, New Haven, Connecticut.

出版信息

J Surg Res. 2020 Jun;250:45-52. doi: 10.1016/j.jss.2019.12.037. Epub 2020 Feb 1.

DOI:10.1016/j.jss.2019.12.037

PMID:32018142

Abstract

BACKGROUND

The Model for End-Stage Liver Disease Sodium (MELD-Na) incorporates hyponatremia into the MELD score and has been shown to correlate with surgical outcomes. The pathophysiology of hyponatremia parallels that of ascites, which purports greater surgical risk. This study investigates whether MELD-Na accurately predicts morbidity and mortality in patients with ascites undergoing general surgery procedures.

MATERIALS AND METHODS

We used the National Surgical Quality Improvement Program database (2005-2014) to examine the adjusted risk of morbidity and mortality of cirrhotic patients with and without ascites undergoing inguinal or ventral hernia repair, cholecystectomy, and lysis of adhesions for bowel obstruction. Patients were stratified by the MELD-Na score and ascites. Outcomes were compared between patients with and without ascites for each stratum using low MELD-Na and no ascites group as a reference.

RESULTS

A total of 30,391 patients were analyzed. Within each MELD-Na stratum, patients with ascites had an increased risk of complications compared with the reference group (low MELD-Na and no ascites): low MELD-Na with ascites odds ratio (OR) 4.33 (95% confidence interval [CI] 1.96-9.59), moderate MELD-Na no ascites OR 1.70 (95% CI 1.52-1.9), moderate MELD-Na with ascites OR 3.69 (95% CI 2.49-5.46), high MELD-Na no ascites OR 3.51 (95% CI 3.07-4.01), and high MELD-Na ascites OR 7.18 (95% CI 5.33-9.67). Similarly, mortality risk was increased in patients with ascites compared with the reference: moderate MELD-Na no ascites OR 3.55 (95% CI 2.22-5.67), moderate MELD-Na ascites OR 13.80 (95% CI 5.65-33.71), high MELD-Na no ascites OR 8.34 (95% CI 5.15-13.51), and high MELD-Na ascites OR 43.97 (95% CI 23.76-81.39).

CONCLUSIONS

MELD-Na underestimates morbidity and mortality risk for general surgery patients with ascites.

摘要

背景

终末期肝病模型钠（MELD-Na）将低钠血症纳入 MELD 评分中，并已证明与手术结果相关。低钠血症的病理生理学与腹水相似，腹水表明手术风险更大。本研究旨在探讨 MELD-Na 是否能准确预测接受普通外科手术的腹水患者的发病率和死亡率。

材料和方法

我们使用国家手术质量改进计划数据库（2005-2014 年），检查肝硬化伴或不伴腹水的患者行腹股沟或腹侧疝修补术、胆囊切除术和粘连松解术治疗肠梗阻的发病率和死亡率的调整风险。根据 MELD-Na 评分和腹水对患者进行分层，在每个 MELD-Na 分层中，与低 MELD-Na 且无腹水组相比，有腹水的患者并发症风险增加：低 MELD-Na 伴腹水比值比（OR）为 4.33（95%置信区间[CI]为 1.96-9.59），中度 MELD-Na 无腹水 OR 为 1.70（95%CI 为 1.52-1.9），中度 MELD-Na 伴腹水 OR 为 3.69（95%CI 为 2.49-5.46），高 MELD-Na 无腹水 OR 为 3.51（95%CI 为 3.07-4.01），高 MELD-Na 伴腹水 OR 为 7.18（95%CI 为 5.33-9.67）。同样，与低 MELD-Na 且无腹水组相比，腹水患者的死亡率风险增加：中度 MELD-Na 无腹水 OR 为 3.55（95%CI 为 2.22-5.67），中度 MELD-Na 伴腹水 OR 为 13.80（95%CI 为 5.65-33.71），高 MELD-Na 无腹水 OR 为 8.34（95%CI 为 5.15-13.51），高 MELD-Na 伴腹水 OR 为 43.97（95%CI 为 23.76-81.39）。