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ORIGINAL ARTICLE
Year : 2020  |  Volume : 6  |  Issue : 3  |  Page : 110-118

Model for end-stage liver disease excluding international normalized ratio (MELD-XI) score independently predicts in-hospital cardiac and 1-year all-cause mortality in noncardiac surgery


Department of Cardiology, Faculty of Medicine, Başkent University, Ankara, Turkey

Correspondence Address:
Dr. Orcun Ciftci
Department of Cardiology, Faculty of Medicine, Baskent University, Yukari Bahçelievler, Mehallesi Maresal Fevzi Çakmak Caddesi No: 45, Çankaya, Ankara 06490
Turkey
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJCA.IJCA_4_20

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Objective: Cardiac adverse events are one of the most-feared complications among patients undergoing noncardiac surgery. Model for end-stage liver disease excluding international normalized ratio (MELD-XI) score has been shown to carry prognostic implications for patients with various cardiac conditions, but it has not been used for patients undergoing noncardiac surgery. We aimed to determine the role of MELD-XI score for the prediction of mortality in high-risk noncardiac surgical candidates. Materials and Methods: Eighty-four patients with high-risk cardiac conditions undergoing elective or urgent noncardiac surgery were reviewed for in-hospital cardiac and 1-year all-cause mortality. MELD-XI score was compared between the surviving and deceased patients. It was correlated with both mortality rates; its predictive power for mortality prediction was tested. Results: The median age was 81 (interquartile range 18) years, and 41 (48.8%) patients were male. All patients had at least one high-risk cardiac condition. Forty patients experienced a cardiac adverse event. Sixteen (19%) patients died at hospital and 40 (47.6%) patients died by 1 year, and both groups had significantly higher MELD-XI scores than survivors (12.23 [6.53] vs. 9.66 [3.81]; P = 0.001 and 10.80 [6.31] vs. 9.70 [3.70]; P = 0.037, respectively). MELD-XI score independently predicted in-hospital cardiac mortality (OR: 1.254 [95% confidence interval [CI]: 1.028–1.530]; P < 0.05) and 1-year all-cause mortality (OR: 1.258 [95% CI: 1.057–1.498; P < 0.01). MELD-XI predicted in-hospital cardiac mortality with a fair sensitivity and a moderate specificity and 1-year all-cause mortality with a fair sensitivity but poor specificity. A MELD-XI score >8.87 was associated with a significantly worse 1-year survival (log rank test, P < 0.05). Conclusion: MELD-XI score is independently associated with in-hospital cardiac and 1-year all-cause mortality among high-risk patients undergoing noncardiac surgery.


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