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World J Hepatol. Apr 27, 2026; 18(4): 116176
Published online Apr 27, 2026. doi: 10.4254/wjh.v18.i4.116176
Published online Apr 27, 2026. doi: 10.4254/wjh.v18.i4.116176
In-hospital mortality and dynamic modified end-stage liver disease score after emergency general surgery in patients with cirrhosis
Ashling L Zhang, Nathnael Tessema, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD 21201, United States
Jaclyn Clark, David T Efron, Mira H Ghneim, Program in Trauma, University of Maryland School of Medicine, R. Adams Cowley Shock Trauma Center, Baltimore, MD 21201, United States
Roumen Vesselinov, Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD 21201, United States
Lindsay O’Meara, Department of Surgery, University of Maryland Medical Center, Baltimore, MD 21201, United States
Author contributions: Zhang AL and Tessema N extracted data from medical records; Zhang AL and Ghneim MH designed the study and were major contributors to the writing of the manuscript; Zhang AL, Vesselinov R, and Ghneim MH performed the statistical analyses; Clark J, O’Meara L, and Efron DT contributed to critical revision of the manuscript; All authors read, revised, and approved the final manuscript.
Institutional review board statement: The study protocol was reviewed and approved by the University of Maryland, Baltimore Institutional Review Board (Approval No. HP-00112669).
Informed consent statement: Patients were not required to give informed consent to the study, because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Data sharing statement: The datasets generated during the current study are not publicly available due to sensitivity and are available from the corresponding author on reasonable request.
Corresponding author: Mira H Ghneim, MD, Associate Professor, FACS, Program in Trauma, University of Maryland School of Medicine, R. Adams Cowley Shock Trauma Center, 22 S. Greene Street, Baltimore, MD 21201, United States. mira.ghneim@som.umaryland.edu
Received: November 5, 2025
Revised: December 9, 2025
Accepted: January 20, 2026
Published online: April 27, 2026
Processing time: 168 Days and 6.5 Hours
Revised: December 9, 2025
Accepted: January 20, 2026
Published online: April 27, 2026
Processing time: 168 Days and 6.5 Hours
Core Tip
Core Tip: For patients with cirrhosis requiring emergency general surgery, initial model for end-stage liver disease (MELD) score alone may be insufficient for perioperative risk assessment, as MELD can change postoperatively. In this single-center retrospective study of 94 patients, MELD at discharge/death was independently associated with in-hospital mortality, whereas admission and day-of-surgery MELD were not. Among 24 patients whose MELD improved after surgery, 92% survived; among 14 whose MELD worsened, 93% died. All patients with final MELD ≥ 30 died. Increases in MELD were driven by bilirubin and creatinine, highlighting the need for targeted postoperative strategies to limit renal and hepatic dysfunction.