Cardiac surgery in patients with liver cirrhosis: Risk factors for predicting mortality
Journal
World Journal of Gastroenterology
Journal Volume
20
Journal Issue
35
Pages
12608-12614
Date Issued
2014
Author(s)
Lin C.-H.
Abstract
AIM: To evaluate the results of cardiac surgery in cirrhotic patients and to find the predictors of early and late mortality. METHODS: We included 55 consecutive cirrhotic patients undergoing cardiac surgery between 1993 and 2012. Child-Turcotte-Pugh (Child) classification and Model for End-Stage Liver Disease (MELD) score were used to assess the severity of liver cirrhosis. The online EuroSCORE II calculator was used to calculate the logistic EuroSCORE in each patient. Stepwise logistic regression analysis was used to identify the risk factors for mortality at different times after surgery. Multivariate Cox proportional hazard models were applied to estimate the hazard ratios (HR) of predictors for mortality. The Kaplan-Meier method was used to generate survival curves, and the survival rates between groups were compared using the log-rank test. RESULTS: There were 30 patients in Child class A, 20 in Child B, and five in Child C. The hospital mortality rate was 16.4%. The actuarial survival rates were 70%, 64%, 56%, and 44% at 1, 2, 3, and 5 years after surgery, respectively. There were no significant differences in major postoperative complications, and early and late mortality between patients with mild and advanced cirrhosis. Multivariate logistic regression showed preoperative serum bilirubin, the EuroSCORE and coronary artery bypass grafting (CABG) were associated with early and late mortality; however, Child class and MELD score were not. Cox regression analysis identified male gender (HR = 0.319; P = 0.009), preoperative serum bilirubin (HR = 1.244; P = 0.044), the EuroSCORE (HR = 1.415; P = 0.001), and CABG (HR = 3.344; P = 0.01) as independent risk factors for overall mortality. CONCLUSION: Advanced liver cirrhosis should not preclude patients from cardiac surgery. Preoperative serum bilirubin, the EuroSCORE, and CABG are major predictors of early and late mortality. ? 2014 Baishideng Publishing Group Inc. All rights reserved.
Subjects
Cardiac surgery; Liver cirrhosis; Risk factor
SDGs
Other Subjects
bilirubin; bilirubin; biological marker; adult; aged; Article; bilirubin blood level; Child Turcotte Pugh score; clinical evaluation; controlled study; coronary artery bypass graft; disease severity; end stage liver disease; EuroSCORE; female; hazard ratio; heart surgery; hospital patient; human; Kaplan Meier method; liver cirrhosis; log rank test; logistic regression analysis; major clinical study; male; mortality; postoperative complication; prediction; proportional hazards model; risk factor; sex difference; surgical mortality; surgical risk; survival rate; treatment outcome; very elderly; adverse effects; blood; chi square distribution; complication; Heart Diseases; heart surgery; liver cirrhosis; middle aged; mortality; multivariate analysis; patient selection; retrospective study; risk; risk assessment; severity of illness index; statistical model; time; young adult; Adult; Aged; Aged, 80 and over; Bilirubin; Biological Markers; Cardiac Surgical Procedures; Chi-Square Distribution; Coronary Artery Bypass; Female; Heart Diseases; Hospital Mortality; Humans; Kaplan-Meier Estimate; Liver Cirrhosis; Logistic Models; Male; Middle Aged; Multivariate Analysis; Odds Ratio; Patient Selection; Postoperative Complications; Proportional Hazards Models; Retrospective Studies; Risk Assessment; Risk Factors; Severity of Illness Index; Sex Factors; Time Factors; Treatment Outcome; Young Adult
Publisher
WJG Press
Type
journal article