Although both scores are detailed and provide a reliable framework for risk assessment in patients undergoing heart surgery, their designs do not provide risk evaluation for patients with liver disease, depending on the severity of the disease. With the rising number of multimorbid patients undergoing cardiac surgery, preoperative risk stratification is becoming increasingly important.Ĭurrent risk stratification scores used for patients undergoing heart surgery include EUROSCORE II and STS Short-Term Risk Calculator. The MELD Score has since also been used to assess the risk of patients with liver cirrhosis undergoing heart surgery. Thus, the MELD Score established itself as a valid method to predict the survival of patients with end-stage liver disease. as a model to predict the outcomes of patients with portal hypertension undergoing Trans jugular intrahepatic portosystemic shunts (TIPS), and was adopted by UNOS to improve allocation times for patients waiting for a liver transplant. The MELD Score was first described by Kamath, Malinchoc, Gordon et al. As the current risk stratification scores do not consider this, we recommend applying the MELD score before considering patients for cardiac surgery. A higher mortality was observed in patients with reduced liver and renal function, with a significant increase in patients with a MELD score > 20. Incidentally, an increased MELD Score was not associated with a significant increase in the postoperative incidence of stroke/TIA or the presence of sternal wound infections/complications. The highest rates of postoperative bleeding (13.8%) and, repeat thoracotomy (13.2%) & postoperative pneumonia (17.4%) were seen in Group 3 (threefold increase when compared to Group 1, renal failure requiring dialysis ( N = 235, 2.7% in Group 1 v/s N = 78, 22.9% in Group 3) or requiring high dose catecholamines post-operatively or mechanical circulatory support (IABP/ECLS). To perform a univariate analysis of the data, patients were classified into three groups based on the MELD Score: MELD 20 experienced a 31.2% postoperative mortality, compared to Group 1 (4.6%) and Group 2 (17.5%). We retrospectively examined patient data using the MELD score as a predictor of mortality. Risk stratification, using scores such as EURO Score II or STS Short-Term Risk Calculator for patients undergoing cardiac surgery with cardiopulmonary bypass, ignores the quantitative renal and hepatic function therefore, MELD-Score was applied in these cases. Efforts at further refinement and validation of the MELD score will continue.The outcome of the patients undergoing cardiac surgery with cardiopulmonary bypass (CPB) is also influenced by the renal and hepatic organ functions. It is possible that the addition of variables that are better determinants of liver and renal function may improve the predictive accuracy of the model. Despite the many advantages of the MELD score, there are approximately 15%-20% of patients whose survival cannot be accurately predicted by the MELD score. MELD may be used in selection of patients for surgery other than liver transplantation and in determining optimal treatment for patients with hepatocellular carcinoma who are not candidates for liver transplantation. However, the MELD score has also been shown to predict survival in patients with cirrhosis who have infections, variceal bleeding, as well as in patients with fulminant hepatic failure and alcoholic hepatitis. The major use of the MELD score has been in allocation of organs for liver transplantation. The MELD which uses only objective variables was validated subsequently as an accurate predictor of survival among different populations of patients with advanced liver disease. The Model for End-stage Liver Disease (MELD) was initially created to predict survival in patients with complications of portal hypertension undergoing elective placement of transjugular intrahepatic portosystemic shunts.
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