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The Role of Model of End Stage Liver Disease (MELD) Score in Predicting Outcomes of Carotid Endarterectomy in Patients with Liver Disease
*Brianna M Krafcik, *Denis Rybin, *Gheorghe Doros, *Mohammad H Eslami, Alik Farber, *Jeffrey A Kalish, *Elizabeth King, *Jeffrey J Siracuse
Boston Medical Center, Boston, MA

Objectives
The Model of End Stage Liver Disease (MELD) score is utilized to characterize and prioritize liver transplantation, however, it has recently been shown to have value in predicting outcomes for patients with a variety of conditions compounded by hepatic/renal dysfunction. We aimed to use MELD score to predict outcomes in asymptomatic patients undergoing carotid endarterectomy (CEA).
Methods
Patients undergoing CEA were identified in the National Surgical Quality Improvement Program (NSQIP) data set (2005-2012). MELD score was calculated using serum bilirubin, creatinine, and the international normalized ratio (INR). Patients were grouped into low (<9), moderate (9-14) and high (15+) MELD classifications. Multivariable logistic and gamma regressions, propensity matching, and propensity weighting were used for analysis. The primary outcome was major adverse cardiovascular events (MACE - composite stroke, cardiac arrest, MI, and death).
Results
There were 8826 CEA performed in asymptomatic patients. Low (<9), moderate (9-14) and high (15+) MELD scores were noted in 6366 (72%), 2126 (24%) and 334 (4%) patients, respectively. Moderate and high MELD scores were not associated with a higher risk of MACE. This was confirmed with matched and weighted analysis. Elevated MELD scores, however, were predictive of bleeding complications and increased operative time and LOS (Table).
Conclusion
An elevated MELD score does not place asymptomatic patients undergoing CEA at a higher risk for MACE. However, these patients have an increased risk of bleeding complications and resource utilization. These findings bear on the decision algorithm for CEA in patients with asymptomatic carotid stenosis and hepatic/renal dysfunction.
Predictors of Complications Based on MELD Score
Perioperative ComplicationModerate MELD (9-14)P-valueHigh MELD (>15)P-value
Death/MI/Stroke (MACE)OR 1.14, 95% CI 0.83-1.570.41OR 1.45, 95% CI 0.80-2.640.22
BleedingOR 1.87, 95% CI 1.22-2.880.004OR 1.28, 95% CI 0.50-3.300.61
Return to OROR 1.17, 95% CI 0.94-1.450.17OR 0.99, 95% CI 0.62-1.580.96
Operative TimeOR 1.01, 95% CI 0.99-1.030.28OR 1.05, 95% CI 1.00-1.100.03
Length of StayOR 1.15, 95% CI 1.11-1.20<0.001OR 1.25, 95% CI 1.15-1.35<0.001


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