Model for end-stage liver disease score versus Child score in predicting the outcome of surgical procedures in patients with cirrhosis

AIM:To determine factors affecting the outcome of patients with cirrhosis undergoing surgery and to compare the capacities of the Child-Turcotte-Pugh(CTP) and model for end-stage liver disease(MELD)score to predict that outcome. METHODS:We reviewed the charts of 195 patients with cirrhosis who underwent surgery at two teaching hospitals over a five-year period.The combined endpoint of death or hepatic decompensation was considered to be the primary endpoint. RESULTS:Patients who reached the endpoint had a higher MELD score,a higher CTP score and were more likely to have undergone an urgent procedure.Among patients undergoing elective surgical procedures,no statistically significant difference was noted in the mean MELD(12.8±3.9 vs 12.6±4.7,P=0.9)or in the mean CTP(7.6±1.2 vs 7.7±1.7,P=0.8)between patients who reached the endpoint and those who did not.Both mean scores were higher in the patients reaching the endpoint in the case of urgent procedures(MELD:22.4± 8.7 vs 15.2±6.4,P=0.0007;CTP:9.9±1.8 vs 8.5±1.8, P=0.008).The performances of the MELD and CTP scores in predicting the outcome of urgent surgery were only fair,without a significant difference between them (AUC=0.755±0.066 for MELD vs AUC=0.696±0.070 for CTP,P=0.3). CONCLUSION:The CTP and MELD scores performedequally,but only fairly in predicting the outcome of urgent surgical procedures.Larger studies are needed to better define the factors capable of predicting the outcome of elective surgical procedures in patients with cirrhosis.

Covid-19 Vaccine Effectiveness in New York State

Background:Population-based data from the United States on the effectiveness of the three coronavirus disease 2019(Covid19)vaccines currently authorized by the Food and Drug Administration are limited.Whether declines in effectiveness are due to waning immunity,the B.1.617.2(delta)variant of the severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),or other causes is unknown.Methods:We used data for 8,690,825 adults in New York State to assess the effectiveness of the BNT162b2,mRNA-1273,and Ad26.COV2.S vaccines against laboratory-confirmed Covid-19 and hospitalization with Covid-19(i.e.,Covid-19 diagnosed at or after admission).We compared cohorts defined according to vaccine product received,age,and month of full vaccination with age-specific unvaccinated cohorts by linking statewide testing,hospital,and vaccine registry databases.We assessed vaccine effectiveness against Covid-19 from May 1 through September 3,2021,and against hospitalization with Covid-19 from May 1 through August 31,2021.