M.E.L.D.-XI: Um factor prognóstico de mortalidade operatória na Cirrose Hepática?

Estudo retrospectivo de 190 doentes

M.E.L.D.-XI na avaliação do risco cirúrgico

 

B. Pinto Costa, F. Castro Sousa, C. Carvalho, M. Serôdio ¹

 

RESUMO

Estudos recentes sugerem que o M.E.L.D. (“Model for End-stage Liver Disease”) pode constituir um factor preditivo de mortalidade operatória em doentes cirróticos. Em 2007, foi proposto um índice análogo (M.E.L.D.-XI), determinado a partir da creatininémia e da bilirrubinémia, para definir a prioridade para transplante dos doentes cirróticos medicados com anti-vitamínicos K. Com o objectivo de avaliar o valor do M.E.L.D-XI na quantificação do risco cirúrgico, comparar o seu valor prognóstico com o M.E.L.D. e a classificação de Child-Turcotte-Pugh e determinar se a sua capacidade prognóstica aumenta com a incorporação do sódio (iM.E.L.D.-XI), efectuou-se um estudo retrospectivo de 190 doentes cirróticos operados entre 1993 e 2008. O M.E.L.D.-XI demonstrou uma significativa capacidade prognóstica de mortalidade operatória (aaR.O.C.=71%; p=0,001), comparável à do M.E.L.D. (aaR.O.C.=76%; p=0,0001) e à da classificação de Child-Turcotte-Pugh (aaR.O.C.=72%; p=0,001). O iM.E.L.D.-XI constituiu um significativo factor prognóstico de mortalidade em cirurgia electiva (aaR.O.C.=83%; p=0,024), com potencial preditivo superior ao iM.E.L.D. (aaR.O.C.=80%; p=0,044), ao M.E.L.D. (aaR.O.C.=61%; n.s.) e à classificação de Child-Turcotte-Pugh (aaR.O.C.=54%; n.s.). O M.E.L.D.-XI e o iM.E.L.D.-XI revelaram-se factores preditivos de mortalidade operatória em doentes cirróticos, com boa correlação com o M.E.L.D. e o iM.E.L.D., podendo ser úteis nos casos de eventual dissociação entre o I.N.R. e a função hepática e na normalização das alterações decorrentes da variabilidade inter-laboratorial do I.N.R.

Palavras-chave: M.E.L.D.-XI, M.E.L.D., iM.E.L.D., Child-Turcotte-Pugh, risco cirúrgico, cirrose.

 

SUMMARY

Recent studies suggested that M.E.L.D. (Model for End-stage Liver Disease) may represent a predictive factor of operative mortality in cirrhotic patients. In 2007, a similar parameter was proposed (M.E.L.D.-XI), based on creatininemia and bilirrubinemia, to be used in the definition of priority for transplantation in patients requiring anticoagulant therapy. To evaluate the value of M.E.L.D.-XI in surgical risk evaluation, to compare its prognostic value with M.E.L.D. and Child-Turcotte-Pugh classification and to determine if its prognostic potential increases with incorporation of natremia (iM.E.L.D.-XI) a retrospective study of 190 operated cirrhotic patients was undertaken. IM.E.L.D. revealed a significant predictive capacity of operative mortality (auR.O.C.=71%; p=0,001), similar to M.E.L.D. (auR.O.C.=76%; p=0,0001) and Child-Turcotte-Pugh classification (auR.O.C.=72%; p=0,001). IM.E.L.D.-XI represented a significant prognostic factor of mortality following elective surgery (auR.O.C.=83%; p=0,024) with better predictive potential than iM.E.L.D. (auR.O.C.=80%; p=0,044), M.E.L.D. (auR.O.C.=61%; n.s.) and Child-Turcotte-Pugh classification (auR.O.C.=54%; n.s.). M.E.L.D.-XI and iM.E.L.D.-XI scores revealed to be predictive parameters of operative mortality in cirrhotic patients, with good correlation with M.E.L.D. and iM.E.L.D.; they may be useful in cases of dissociation of I.N.R. in relation to liver function and in normalization of discrepancies associated with interlaboratory variability of I.N.R.. Further studies are needed to clarify the applicability of M.E.L.D.-XI in surgical risk evaluation of cirrhotic patients.

Keywords: M.E.L.D.-XI, M.E.L.D., iM.E.L.D., Child-Turcotte-Pugh, surgical risk, cirrhosis

 

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¹ Serviço de Cirurgia III dos Hospitais da Universidade de Coimbra

 

Correspondência:

Beatriz Pinto da Costa

Clínica Universitária de Cirurgia III

Hospitais da Universidade de Coimbra

Praceta Prof. Mota Pinto

3000-075 Coimbra

Telefone: 239400417

Fax: 239402111

beatrizpcosta@huc.min-saude.pt

 

Recebido para publicação: 29/11/2008

Aceite para publicação: 12/02/2009