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Association Of Liver Dysfunction With Outcomes After Cardiac Surgery - A Meta-analysis
Giovanni Jr Soletti1, Katia Audisio1, Hristo Kirov2, Tulio Caldonazo2, Mohamed Rahouma1, N. Bryce Robinson1, Gianmarco Cancelli1, Michelle Demetres1, Torsten Doenst2, Mario Gaudino1.
1Weill Cornell Medicine, New York, NY, USA, 2Friedrich Schiller University, Jena, Germany.

OBJECTIVE - To evaluate outcomes of patients with liver dysfunction (LD) undergoing open heart surgery (OHS).METHODS - A systematic literature search was conducted to identify studies reporting short- and long-term outcomes in patients with LD (high-score group, HSG) compared to patients with no or mild LD (low-score group, LSG) undergoing OHS. The severity of the LD was assessed using the Child-Turcotte-Pugh (CTP) score, the Model for End-stage Liver Disease (MELD) score, or both. The primary outcome was perioperative mortality. The secondary outcomes were postoperative neurological events, prolonged ventilation, sepsis, bleeding and/or need for transfusion, acute kidney injury, and long-term mortality. Meta-regression was used to explore the association between baseline characteristics and the primary outcome.RESULTS - A total of 33 studies with 48,891 patients (LSG: 29,912, HSG: 18,979) were included. Compared with the LSG, the HSG was associated with significantly higher risk of perioperative mortality (OR 3.72, 95%CI 2.75-5.03, P<0.001) (Figure 1). The HSG was also associated with a significantly higher rate of postoperative neurological events (OR 1.49, 95%CI 1.30-1.71, P<0.001), prolonged ventilation (OR 2.45, 95%CI 1.94-3.09, P<0.001), sepsis (OR 3.88, 95%CI 2.07-7.26, P<0.001), bleeding and/or need for transfusion (OR 1.95, 95%CI 1.43-2.64, P<0.001), acute kidney injury (OR 3.84, 95%CI 2.12-6.98, P<0.001), and long-term mortality (IRR 0.78, 95%CI 0.69-0.88, P<0.001) (Table 1). At meta-regression, the assessed variables did not show any significant association with the pooled estimate for perioperative mortality.CONCLUSIONS - Severe preoperative LD negatively affects short- and long-term outcomes of patients undergoing OHS, including perioperative and long-term mortality.


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