Serum Markers for Predicting Abdominal Surgery Outcomes in Patients with Cirrhosis

Background: Determinants 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. Methods: A 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). Results: Albumin 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). Conclusion: Augmenting 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.