MELD SCORE COMPARED TO CHILD- TURCOTTE- PUGH SCORE AS A PREDICTOR OF POSTOPERATIVE MORTALITY IN PATIENTS WITH LIVER CIRRHOSIS UNDERGOING NON-HEPATIC SURGERY

Abstract

Two risk stratifications schemes have been used to estimate the perioperative risk of patients with cirrhosis: the Child-Turcotte-Pugh score and the Model for End-Stage Liver Disease (MELD) score. The MELD scoring system has not been used to evaluate surgical risk in patients with liver cirrhosis undergoing non hepatic surgery under general anesthesia. Hence was the need to compare it with the CTP score to determine surgical risk and prediction of outcome. The aim of this study was to evaluate the MELD scoring system as compared to the CTP score as a predictor of 30- day mortality in patients with liver cirrhosis undergoing non-hepatic surgery under general anesthesia. This study was conducted on 80 patients admitted at Ain shams University Hospitals. Patients undergoing non-hepatic surgeries such as (appendicectomy, orthopedic surgeries, hernioplasty…..) under general anesthesia were included in this Study. Patients were divided into two groups as follow: Group A: 60 patients with liver cirrhosis (diagnosed on the basis of clinical, biochemical and radiological criteria). Group B: A control group of 20 patients without any clinical, biochemical or radiologic evidence of liver disease undergoing surgical procedures. A significant prediction of mortality with the increase in MELD score in logistic regression model was detected (14% higher increase in relative risk of mortality with each increase in score of MELD). The sensitivity and the negative predictive value of MELD score were higher than those of child score for detection of 30- day mortality in patients with liver cirrhosis undergoing non-hepatic surgery under general anesthesia.

Conclusion MELD score is more reliable than Child- Turcotte- Pugh score as a predictor of postoperative mortality in patients with liver cirrhosis undergoing non-hepatic surgeries.