Serum Markers for Predicting Abdominal Surgery Outcomes in Patients with Cirrhosis

Abstract

BackgroundDeterminants of adverse events for cirrhotic patients undergoing abdominal surgery have not been adequately assessed. Child–Turcotte–Pugh (CTP) and Model for End-Stage Liver Disease (MELD) have estimated perioperative outcomes with inconsistent results. Our study sought to combine novel serum markers with CTP and MELD to improve prognostication of 30-day postoperative mortality or liver transplant in cirrhotic patients undergoing abdominal surgery. MethodsA review was performed on 120 cirrhotic patients undergoing nonhepatic abdominal surgeries at Mount Sinai Medical Center from 2001–2011. Preoperative serum markers were evaluated by logistic regression and receiver–operator characteristics. Prognostic ability of scoring systems was assessed using Youden’s J statistic (J). ResultsAlbumin and hematocrit were independently predictive of 30-day mortality or transplant with optimal cutoff values of albumin at <3.05 mg/dl and hematocrit at <35.55 %. Adding these criteria to CTP>A, CTP>B, MELD ≥ 10, MELD ≥ 15, and MELD ≥ 20 improved sensitivity and specificity by an average of 6.1 and 32.1 %, respectively. The highest J values resulted from combining novel criteria with CTP>A (sensitivity, 80 %; specificity, 82 %; p < 0.01; J, 0.63) and MELD ≥ 10 (sensitivity, 63 %; specificity, 90 %; p < 0.01; J, 0.53). ConclusionAugmenting CTP and MELD with albumin and hematocrit significantly improved the identification of cirrhotic patients at risk of 30-day mortality or transplantation following nonhepatic abdominal surgery.