12/16/2023 0 Comments Meld score mortality tipsAlthough the CTP is criticized for its subjectivity and heterogeneity within a class, a patient with severe portal hypertension may not have a MELD score that reflects the severity of their illness. 6 There is still a debate whether the CTP or MELD score is more accurate at predicting postoperative mortality. Median survival based on the MELD score is shown in Table Table2 2. For every MELD score point increase above 8, there was a 14% increase in mortality in the first 30 to 90 days. 4, 5 A large retrospective study of 772 individuals who underwent digestive, orthopedic, or cardiovascular surgeries demonstrated that the MELD score was an independent predictor of postoperative mortality. The CTP score emphasizes the sequelae of portal hypertension have been validated in several small retrospective studies with mortality rates as high as 30% to 31% for Child class B and 76% to 82% for Child class C cirrhotic patients. Both scores have been applied to preoperative risk stratification, with higher MELD and CTP scores correlating with higher 30‐day mortality. The two most commonly used scores to stratify liver disease severity are the Child‐Turcotte‐Pugh (CTP) and the Model for End‐Stage Liver Disease (MELD). Once the diagnosis of cirrhosis is established, further risk stratification depends largely on the degree of hepatocellular dysfunction. Indicators of significant portal hypertension include thrombocytopenia (platelets <150), the presence of splenomegaly, varices, or ascites, and a hepatic venous pressure gradient greater than 10. 3 Those who have cirrhosis should undergo further testing to identify the presence of clinically significant portal hypertension, because this increases their risk for hypoxemic tissue injury. Patients with chronic liver disease, but no cirrhosis do not have this susceptible hemodynamic profile and should be risk‐stratified similarly to the general population. Cirrhotic patients are highly susceptible to these shifts, which result in hypoxemic injury to the liver and can lead to hepatic decompensation. Surgical procedures are often a state of constant hemodynamic shifts because of the vasoactive properties of anaesthesia and intraoperative blood loss. Cirrhosis is a state of decreased systemic vascular resistance, and blood flow to the liver is often reduced, especially in the presence of portal hypertension. A key distinction that helps prognosticate postoperative outcomes is the presence or absence of cirrhosis.
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