Using Noninvasive Clinical Parameters To Predict Mortality and Morbidity After Cardiac Interventions in Patients With Cirrhosis: A Systematic Review

Authors

Christo Mathew
Ankur Patel
George Cholankeril
Avegail Flores
Ruben Hernaez

Publication Date

1-1-2024

Journal

Saudi Journal of Gastroenterology

DOI

10.4103/sjg.sjg_263_23

PMID

37988070

PMCID

PMC10852145

PubMedCentral® Posted Date

11-18-2023

PubMedCentral® Full Text Version

Post-print

Published Open-Access

yes

Keywords

Humans, End Stage Liver Disease, Liver Cirrhosis, Morbidity, Severity of Illness Index, Treatment Outcome, Cardiac procedures, morbidity, mortality, risk prediction

Abstract

BACKGROUND: Cardiovascular disease commonly affects advanced liver disease patients. They undergo cardiac interventions to improve cardiac outcomes. Cirrhosis increases complication risk, including bleeding, renal and respiratory failure, and further decompensation, including death, posing a clinical dilemma to proceduralists. Predicting outcomes is crucial in managing patients with cirrhosis. Our aim was to systematically review clinical parameters to assess the mortality and complication risk in patients with cirrhosis undergoing cardiac interventions.

METHODS: We searched cirrhosis and cardiovascular intervention terminology in PubMed and Excerpta Medica Database (EMBASE) from inception to January 8, 2023. We included studies reporting clinical scores (e.g. Model for End-stage Liver Disease (MELD), Child-Pugh-Turcotte (CPT), cardiovascular interventions, mortality, and morbidity outcomes). We independently abstracted data from eligible studies and performed qualitative summaries.

RESULTS: Eight studies met the inclusion criteria. Procedures included tricuspid valve surgery, catheterization-related procedures, aortic valve replacement (AVR), pericardiectomy, and left ventricular assist device (LVAD) placement. MELD primarily predicted mortality (n = 4), followed by CPT (n = 2). Mortality is significantly increased for MELD > 15 after tricuspid valve surgery. Albumin, creatinine, and MELD were significantly associated with increased mortality after transcatheter AVR (TAVR), although specific values lacked stratification. CPT was significantly associated with increased mortality after cardiac catheterization or pericardiectomy. In LVAD placement, increasing MELD increased the unadjusted odds for perioperative mortality.

CONCLUSIONS: Our systematic review showed that clinical parameters predict mortality and morbidity risk in patients with cirrhosis undergoing cardiac procedures.