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Original Investigation
Pacific Coast Surgical Association
July 20, 2016

Association of Model for End-Stage Liver Disease Score With Mortality in Emergency General Surgery Patients

Author Affiliations
  • 1Center for Surgery and Public Health, Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
  • 2Division of Trauma, Burns, and Surgical Critical Care, Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
  • 3The Nathan E. Hellman Memorial Laboratory, Renal Division, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
JAMA Surg. 2016;151(7):e160789. doi:10.1001/jamasurg.2016.0789

Importance  Emergency general surgery (EGS) patients have a disproportionate burden of death and complications. Chronic liver disease (CLD) increases the risk of complications following elective surgery. For EGS patients with CLD, long-term outcomes are unknown and risk stratification models do not reflect severity of CLD.

Objective  To determine whether the Model for End-Stage Liver Disease (MELD) score is associated with increased risk of 90-day mortality following intensive care unit (ICU) admission in EGS patients.

Design, Setting, and Participants  We performed a retrospective cohort study of patients with CLD who underwent an EGS procedure based on International Classification of Diseases, Ninth Revision (ICD-9) procedure codes and were admitted to a medical or surgical ICU within 48 hours of surgery between January 1, 1998, and September 20, 2012, at 2 academic medical centers. Chronic liver disease was identified using ICD-9 codes. Multivariable logistic regression was performed. The analysis was conducted from July 1, 2015, to January 1, 2016.

Main Outcomes and Measures  The primary outcome was all-cause 90-day mortality.

Results  A total of 13 552 EGS patients received critical care; of these, 707 (5%) (mean [SD] age at hospital admission, 56.6 [14.2] years; 64% male; 79% white) had CLD and data to determine MELD score at ICU admission. The median MELD score was 14 (interquartile range, 10-20). Overall 90-day mortality was 30.1%. The adjusted odds ratio of 90-day mortality for each 10-point increase in MELD score was 1.63 (95% CI, 1.34-1.98). A decrease in MELD score of more than 3 in the 48 hours following ICU admission was associated with a 2.2-fold decrease in 90-day mortality (odds ratio = 0.46; 95% CI, 0.22-0.98).

Conclusions and Relevance  In this study, MELD score was associated with 90-day mortality following EGS in patients with CLD. The MELD score can be used as a prognostic factor in this patient population and should be used in preoperative risk prediction models and when counseling EGS patients on the risks and benefits of operative intervention.