Risk Factors for Mortality After Surgery in Patients With Cirrhosis.

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Title：Risk Factors for Mortality After Surgery in Patients With Cirrhosis.
题目：肝硬化患者术后致死的危险因素
Author：Teh SH, Nagorney DM, Stevens SR, Offord KP, Therneau TM, Plevak DJ, Talwalkar JA, Kim WR, Kamath PS.
作者：Teh SH, Nagorney DM, Stevens SR等

Resource: Gastroenterology. 2007 Jan 25;
文章来源：胃肠病杂志. 2007 Jan 25;

Abstract: 摘要
BACKGROUND & AIMS:背景和目的
Current methods of predicting risk of postoperative mortality in patients with cirrhosis are suboptimal.目前预测肝硬化患者术后死亡风险的方法并不令人满意。
The utility of the Model for End-stage Liver Disease (MELD) in predicting mortality after surgery other than liver transplantation is unknown.
MELD在肝移植以外的手术风险预测价值尚不清楚。
The aim of this study was to determine the risk factors for postoperative mortality in patients with cirrhosis.
本研究的目的是明确肝硬化患者术后的危险因素。
METHODS:方法
Patients with cirrhosis (N = 772) who underwent major digestive (n = 586), orthopedic (n = 107), or cardiovascular (n = 79) surgery were studied. Control groups of patients with cirrhosis included 303 undergoing minor surgical procedures and 562 ambulatory patients.
研究对象为肝硬化病人772例，其中主要消化道手术596例，矫形外科手术107 例，心血管手术79例。Univariate and multivariable proportional hazards analyses were used to determine the relationship between risk factors and mortality.
单因素和多因素比例风险分析用于确定各危险因素与死亡率之间的关系。
RESULTS: 结果
Patients undergoing major surgery were at increased risk for mortality up to 90 days postoperatively. 患者大的手术术后90天内死亡危险增加。
By multivariable analysis, only MELD score, American Society of Anesthesiologists class, and age predicted mortality at 30 and 90 days, 1 year, and long-term, independently of type or year of surgery.
多变量分析提示，只有MELD评分、美国麻醉医师学会分级和患者年龄是预测患者术后30天和90天、1年和长期随访死亡率的独立危险因素，与手术类型和手术时间无关。
Emergency surgery was the only independent predictor of duration of hospitalization postoperatively. Thirty-day mortality ranged from 5.7% (MELD score, <8) to more than 50% (MELD score, >20).
急诊手术仅仅是术后住院期间的独立危险因素。术后30天的死亡率为5.7％（MELD 小于8分）至50％（MELD大于20分）。
The relationship between MELD score and mortality persisted throughout the 20-year postoperative period.
MELD评分和死亡率之间的相关性持续到术后20年。
CONCLUSIONS: 结论
MELD score, age, and American Society of Anesthesiologists class can quantify the risk of mortality postoperatively in patients with cirrhosis, independently of the procedure performed.
MELD评分、患者年龄和美国麻醉医师学会分级能够定量反映肝硬化患者术后死亡风险，而不受手术情况的影响。
These factors can be used in determining operative mortality risk and whether elective surgical procedures can be delayed until after liver transplantation.
这些因素可以用于确定手术死亡风险，以及择期手术是否延期到肝移植术后。