Management of cirrhotic patients with blunt abdominal trauma: Analysis of risk factor of postoperative death with the Model for End-Stage Liver Disease score
Lin BC et al. – Liver cirrhosis with blunt abdominal trauma (BAT) has a high operative rate, low salvage rate of NOM, high surgical mortality and morbidity rate. The Model for End–Stage Liver Disease (MELD) score can accurately predict postoperative death and a MELD score equal to or above 17 of the data is at high risk of postoperative death.Methods
- From July 1993 to June 2005, 34 cirrhotic patients with BAT were reviewed.
- Data are presented as mean±standard deviation (SD), frequency (percentage), or Pearson correlation coefficient.
- Predictors were compared by uni– and multiple logistic regression analysis and results were considered statistically significant if P<0.05.
- The prognostic value of the MELD score in predicting postoperative death was assessed using receiver operating characteristic (ROC) curve analysis.
- Of the 34 patients (27 men, 7 women; mean age, 49years), the Injury Severity Score (ISS) ranged from 4 to 43 (mean:14).
- Of the 34 patients, 12 were treated with nonoperative management (NOM) initially and 4 succeeded and 30 patients (88.2%) eventually required laparotomy.
- Of the 30 operative patients, 7 died of haemorrhagic shock and the other 6 died of multiple organ failure with a 43.3% mortality rate.
- Of the 17 survivors after laparotomy, 4 developed intra–abdominal complication, and 3 developed extra–abdominal complication with a 41.2% morbidity rate
- On univariate analysis, the significant predictors of surgical mortality were shock at emergency department, damage control laparotomy, ISS and MELD score.
- On multiple logistic regression analysis, the significant predictors of operative mortality were shock at ED (P=0.021) and MELD score (P=0.012).
- Analysis by ROC curve identified cirrhotic patients with a MELD score equal to or above 17 as the best cut–off value for predicting postoperative death.