The Impact of Complications of Cirrhosis in Patients Undergoing Cardiac Surgery: A Propensity Matched Cohort Study
Bibliographic record
Abstract
Background: Patients with cirrhosis and concomitant coronary/valvular heart disease present a clinical dilemma. Cardiac surgeons often are reluctant to operate in this high-risk population, potentially diminishing survival/potential for liver transplant. This study aimed to identify associations between the severity of cirrhosis and post-cardiac surgical outcomes. Methods: We performed a retrospective study of propensity matched cohorts of patients undergoing cardiac surgery from APPROACH database at the University of Alberta Hospital from January 2004 to December 2014. The relationship between severity of liver disease, medical comorbidity and surgical factors on survival to hospital discharge were evaluated. Key summary: Among 60 subjects with cirrhosis, the overall mortality was 40%. Compared with non-cirrhotic patients (n=310), cirrhotics had more postoperative complications (respiratory and renal failure), longer cardiopulmonary bypass time [128 (99 - 200) vs 116 (83 - 161) minutes, p=0.02] and required more blood products during surgery (58% vs 43%, p=0.03). Cirrhotics also had longer median length of stay in ICU [5 (3 -11) vs 2 (1 - 4), p=0.00001] and were more likely to be on mechanical ventilation [2 (1 - 5) vs 1(0.5 -1.2), p=0.00001] and renal replacement therapy (15% vs 6%, p=0.02) post-operatively. After adjusting for other covariates, presence of cirrhosis [aOR: 2.2 (95%CI: 1.10 - 4.22)], increased CCI [aOR: 1.4 (95%CI: 1.18 - 1.60)] and the need for any intraoperative transfusion [aOR: 2.6 (95%CI: 1.28 - 5.04)] were independently associated with increased mortality. Conclusion: Mortality rates were significantly high in cirrhotics undergoing cardiac surgery compared to their non-cirrhotic counterparts despite having lower median MELD scores. Compared with non-cirrhotic patients, cirrhotics undergoing surgery had more postoperative complications, had a higher overall burden on preoperative illness (CCI) and required more medical services and organ support post-operatively.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".