Search

Background: The importance of liver dysfunction in predicting mortality in patients undergoing cardiovascular surgery is an important topic due to the general desire to improve current risk scores such as EUROSCORE II (European System for Cardiac Operative Risk Evaluation), with EUROSCORE III being currently under development. The model for End-Stage Liver Disease (MELD) Score has already proven its utility in predicting outcomes for patients undergoing abdominal, cardiovascular or urological surgery. In the present study, we want to see its usefulness in proving the postoperative mortality in patients undergoing coronary artery bypass surgery. Methods: This was a retrospective study, and it included 185 patients, with 93 survivors being randomly chosen from a total of 589 surviving patients using age, emergency and the weight of cardiac procedures as criteria to match the 92 deceased patients during hospitalization in the postoperative period who underwent coronary artery bypass grafting (CABG) alone or CABG and other concomitant cardiovascular interventions during a 10-year period of time. We calculated for all these patients, at the time of admission, the MELD Score and EUROSCORE II, and we analyzed the predictive performance of the two scores and their constituents. Results: In the multivariable model, patients with a MELD Score ≥ 5.54 had a 2.38-fold increased risk of death (95% C.I.: 1.43–3.96, p = 0.001), while those with a EUROSCORE ≥ 10.37 had a 8.66-fold increased risk of death (95% C.I.: 3.09–24.29, p < 0.001). After combining the two scores, the conditional scenario achieved a high overall accuracy of 84.32% (p < 0.001) in predicting mortality. Conclusions: Patients with a MELD Score ≥ 5.54, had good sensitivity and a very good specificity in terms of mortality prediction, but the conditional scenario, leveraging both risk scores, i.e., the MELD Score and EUROSCORE, offers the highest utility in terms of enhancing mortality prediction regarding these patients. [ABSTRACT FROM AUTHOR]

The Model for End-Stage Liver Disease (MELD) score is a widely used tool for quantifying hepatic dysfunction, providing greater accuracy and a wider range of values compared to the Child-Turcotte-Pugh (CTP) score, being also used in prioritizing patients who are eligible for liver transplantation. This study assessed the correlation between the MELD score and the European System for Cardiac Operative Risk Evaluation II (EuroSCORE II), a reliable system for categorizing risk levels in patients undergoing cardiovascular surgery. This retrospective study analyzed data from 589 patients who underwent coronary artery bypass grafting (CABG) at the Institute of Cardiovascular Diseases 'Prof. Dr. George I.M. Georgescu' in Iași between January 2011 and December 2020. Data collected included demographical, clinical, biochemical, and intraoperative parameters. The average MELD score was 6.09 ± 4.1 (median = 5.72), and the average EuroSCORE II was 6.28 ± 8 (median = 3.85). A significant but relatively modest positive relationship was found between the MELD score and EuroSCORE II, with a correlation coefficient of 0.23 and a corresponding significance level of 0.001. This study demonstrates a positive correlation between MELD and Euro- SCORE II in patients who underwent CABG. Incorporating the MELD score into the preoperative risk assessment of cardiac surgery patients could help identify high-risk individuals and guide clinical decision-making. [ABSTRACT FROM AUTHOR]

Hemophilia patients have a deficiency in or dysfunction of clotting factors, which can lead to a bleeding tendency. However, paradoxically, some hemophilia patients may also be at an increased risk of developing thrombotic events such as deep vein thrombosis or pulmonary embolism. The pathophysiology of thrombosis in hemophilia patients is not fully understood, but it is thought to involve a complex interplay of various factors, including the severity of the hemophilia, the presence of other risk factors such as obesity, smoking, or the use of hormonal therapies, and the presence of certain genetic mutations that increase the risk of thrombosis. In addition, it has been suggested that the use of clotting factor replacement therapy, which is a standard treatment for hemophilia, may also contribute to the development of thrombosis in some cases. [ABSTRACT FROM AUTHOR]

Background Coronary artery bypass grafting (CABG) is a common surgical intervention used to treat severe coronary artery disease. The Model for End-Stage Liver Disease (MELD) score has become a widely used prognostic index for assessing the severity of liver disease and prioritizing liver transplantation. However, its utility in predicting outcomes in cardiac surgery procedures has not been extensively evaluated. Methods This retrospective study gathered data on patients who underwent CABG or CABG combined with other concomitant surgical interventions, such as carotid common or external carotid artery endarterectomy, thoracic aortic aneurysm repair, and aortic or mitral valve replacement or decalcification procedures, at a single tertiary care facility from January 2011 to December 2020. Researchers collected demographic, clinical, and laboratory information, including MELD score and European System for Cardiac Operative Risk Evaluation (EuroSCORE) data. The patients were divided into two groups: the first group included only those who underwent CABG, while the second group comprised patients who underwent CABG along with other concomitant cardiac interventions. Results The MELD score at discharge was significantly higher in the CABG and other interventions group compared to the CABG-only group (median = 14.09, IQR = 7.41-18.7 vs. median = 6.41, IQR = 4.61-9.44, p < 0.001). However, the difference in MELD score at admission between the two groups was not statistically significant (p = 0.328). A p-value < 0.05 was considered statistically relevant, indicating that liver function worsened postoperatively in the patients with additional interventions. The EuroSCORE was also significantly higher in the CABG and other interventions group, suggesting a higher surgical risk as expected (median = 5.74, IQR = 3.54-11.47 vs. median = 3.34, IQR = 1.97-5.66, p < 0.001). Additionally, differences in laboratory parameters, especially coagulation and hemostasis indicators throughout the postoperative period, including the ICU stay (divided into four equal periods based on each patient's total ICU length of stay) and at discharge, indicate a more complex biological state in patients with additional interventions. These findings may have implications for perioperative management and long-term outcomes. Conclusions The elevated MELD score in patients undergoing CABG with additional interventions emphasizes the need for close monitoring of liver function and coagulation status. Evaluating hepatic status preoperatively would be beneficial, and incorporating liver-protective strategies could help mitigate postoperative repercussions. It may also be useful to include liver function parameters in existing cardiovascular risk scores to improve risk assessment., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Research Ethics Committee of Grigore T. Popa University of Medicine and Pharmacy issued approval 163/21.03.2022. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Ludusanu et al.)