Abstract

COSTA, B. Pinto; SOUSA, F. Castro; CARVALHO, C.  and  SERODIO, M.. M.E.L.D.-XI: Um factor prognóstico de mortalidade operatória na Cirrose Hepática? Estudo retrospectivo de 190 doentes: M.E.L.D.-XI na avaliação do risco cirúrgico. J Port Gastrenterol. [online]. 2009, vol.16, n.2, pp.58-67. ISSN 0872-8178.

Recent studies suggested that M.E.L.D. (Model for End-stage Liver Disease) may represent a predictive factor of operative mortality in cirrhotic patients. In 2007, a similar parameter was proposed (M.E.L.D.-XI), based on creatininemia and bilirrubinemia, to be used in the definition of priority for transplantation in patients requiring anticoagulant therapy. To evaluate the value of M.E.L.D.-XI in surgical risk evaluation, to compare its prognostic value with M.E.L.D. and Child-Turcotte-Pugh classification and to determine if its prognostic potential increases with incorporation of natremia (iM.E.L.D.-XI) a retrospective study of 190 operated cirrhotic patients was undertaken. IM.E.L.D. revealed a significant predictive capacity of operative mortality (auR.O.C.=71%; p=0,001), similar to M.E.L.D. (auR.O.C.=76%; p=0,0001) and Child-Turcotte-Pugh classification (auR.O.C.=72%; p=0,001). IM.E.L.D.-XI represented a significant prognostic factor of mortality following elective surgery (auR.O.C.=83%; p=0,024) with better predictive potential than iM.E.L.D. (auR.O.C.=80%; p=0,044), M.E.L.D. (auR.O.C.=61%; n.s.) and Child-Turcotte-Pugh classification (auR.O.C.=54%; n.s.). M.E.L.D.-XI and iM.E.L.D.-XI scores revealed to be predictive parameters of operative mortality in cirrhotic patients, with good correlation with M.E.L.D. and iM.E.L.D.; they may be useful in cases of dissociation of I.N.R. in relation to liver function and in normalization of discrepancies associated with interlaboratory variability of I.N.R.. Further studies are needed to clarify the applicability of M.E.L.D.-XI in surgical risk evaluation of cirrhotic patients.

Keywords : M.E.L.D.-XI; M.E.L.D.; iM.E.L.D.; Child-Turcotte-Pugh; surgical risk; cirrhosis.

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