{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T10:43:26Z","timestamp":1776077006270,"version":"3.50.1"},"reference-count":44,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,4,11]],"date-time":"2026-04-11T00:00:00Z","timestamp":1775865600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Perioperative risk stratification in cardiac surgery is based mainly on static preoperative variables and therefore does not fully capture dynamic multiorgan responses to surgical stress. The Model for End-Stage Liver Disease (MELD) score, which integrates bilirubin, creatinine, and the international normalized ratio (INR), reflects hepatorenal function, but its perioperative dynamics remain insufficiently explored. This study aimed to characterize perioperative MELD trajectories in patients undergoing off-pump coronary artery bypass grafting (OPCAB) and to assess the influence of sex and diabetes mellitus on these changes and their clinical relevance. Methods: This retrospective observational study included 111 patients undergoing elective OPCAB. MELD scores were assessed preoperatively (MELD0), on postoperative day 1 (MELD1), and on day 6 (MELD6). Dynamic indices of MELD change were calculated, including the early postoperative increase (\u0394MELD01). The effects of sex and diabetes mellitus on MELD trajectories were analyzed using multivariable linear regression and generalized estimating equations. A high-surge phenotype was defined as the upper quartile of \u0394MELD01. Results: MELD increased significantly on postoperative day 1 and partially recovered by day 6 (p &lt; 0.001). Female sex was independently associated with lower postoperative MELD values (\u03b2 = \u22122.54, p &lt; 0.001) and a smaller \u0394MELD01, whereas diabetes mellitus was associated with a reduced MELD rise (\u03b2 = \u22121.07, p = 0.028). Patients with a high-surge MELD phenotype had significantly longer hospitalization than those with a lower MELD response (12.8 \u00b1 2.1 vs. 9.2 \u00b1 1.2 days, p &lt; 0.001). Conclusions: Perioperative MELD trajectories reflect a dynamic hepatorenal stress response after OPCAB and may improve identification of clinically relevant physiological vulnerability.<\/jats:p>","DOI":"10.3390\/jcm15082906","type":"journal-article","created":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T08:49:02Z","timestamp":1776070142000},"page":"2906","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Sex- and Diabetes-Dependent Perioperative Model for End-Stage Liver Disease Trajectories Identify Distinct Hepatorenal Stress Phenotypes After Surgical Coronary Revascularization"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8080-2764","authenticated-orcid":false,"given":"Tomasz","family":"Urbanowicz","sequence":"first","affiliation":[{"name":"Cardiac Surgery and Transplantology Department, Poznan University of Medical Sciences, \u00bd D\u0142uga Street, 61-848 Poznan, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-7401-5645","authenticated-orcid":false,"given":"Monika","family":"Bajsert","sequence":"additional","affiliation":[{"name":"Cardiac Surgery Students\u2019 Research Group, Poznan University of Medical Sciences, 10 Fredry Street, 61-701 Poznan, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ewelina","family":"Grywalska","sequence":"additional","affiliation":[{"name":"Department of Experimental Immunology, Medical University of Lublin, 6 Chod\u017aki Street, 20-093 Lublin, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Krzysztof J.","family":"Filipiak","sequence":"additional","affiliation":[{"name":"The Centre of Postgraduate Medical Education, 99\/103 Marymoncka Street, 01-813 Warsaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3464-1645","authenticated-orcid":false,"given":"Beata","family":"Krasi\u0144ska","sequence":"additional","affiliation":[{"name":"Department of Hypertensiology, Angiology, and Internal Medicine, Poznan University of Medical Sciences, \u00bd D\u0142uga Street, 61-848 Poznan, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9530-6659","authenticated-orcid":false,"given":"Paulina","family":"Mertowska","sequence":"additional","affiliation":[{"name":"Department of Experimental Immunology, Medical University of Lublin, 6 Chod\u017aki Street, 20-093 Lublin, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Monika","family":"Kowalczyk","sequence":"additional","affiliation":[{"name":"Cardiac Surgery Students\u2019 Research Group, Poznan University of Medical Sciences, 10 Fredry Street, 61-701 Poznan, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7121-1396","authenticated-orcid":false,"given":"Sebastian","family":"Mertowski","sequence":"additional","affiliation":[{"name":"Department of Experimental Immunology, Medical University of Lublin, 6 Chod\u017aki Street, 20-093 Lublin, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-8684-5603","authenticated-orcid":false,"given":"Zuzanna","family":"Marcinkowska","sequence":"additional","affiliation":[{"name":"Cardiac Surgery Students\u2019 Research Group, Poznan University of Medical Sciences, 10 Fredry Street, 61-701 Poznan, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mansur","family":"Rahnama","sequence":"additional","affiliation":[{"name":"Department of Dental Surgery, Medical University of Lublin, 6 Chod\u017aki Street, 20-093 Lublin, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-9597-8486","authenticated-orcid":false,"given":"Oksana","family":"Wi\u015bniewska","sequence":"additional","affiliation":[{"name":"Cardiac Surgery Students\u2019 Research Group, Poznan University of Medical Sciences, 10 Fredry Street, 61-701 Poznan, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-3858-5809","authenticated-orcid":false,"given":"Julia","family":"Gierszewska","sequence":"additional","affiliation":[{"name":"Cardiac Surgery Students\u2019 Research Group, Poznan University of Medical Sciences, 10 Fredry Street, 61-701 Poznan, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4213-8708","authenticated-orcid":false,"given":"Anna","family":"Olasi\u0144ska-Wi\u015bniewska","sequence":"additional","affiliation":[{"name":"Cardiac Surgery and Transplantology Department, Poznan University of Medical Sciences, \u00bd D\u0142uga Street, 61-848 Poznan, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6752-6002","authenticated-orcid":false,"given":"Ewelina","family":"Swora-Cwynar","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Diabetes and Internal Diseases, Poznan University of Medical Sciences, 49 Przybyszewskiego Street, 61-701 Poznan, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3457-6978","authenticated-orcid":false,"given":"Krzysztof","family":"Bartu\u015b","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery and Transplantology, Jagiellonian University Medical College, 80 Pradnicka Street, 31-202 Cracow, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2798-1959","authenticated-orcid":false,"given":"Zbigniew","family":"Krasi\u0144ski","sequence":"additional","affiliation":[{"name":"Department of Vascular, Endovascular Surgery, Angiology and Phlebology, Poznan University of Medical Sciences, \u00bd Dluga Street, 61-848 Poznan, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Assad","family":"Haneya","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Heart Centre Trier, Barmherzigen Brueder Hospital, 54292 Trier, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2442-4644","authenticated-orcid":false,"given":"Marek","family":"Jemielity","sequence":"additional","affiliation":[{"name":"Cardiac Surgery and Transplantology Department, Poznan University of Medical Sciences, \u00bd D\u0142uga Street, 61-848 Poznan, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"100535","DOI":"10.1016\/j.aohep.2021.100535","article-title":"From Child-Pugh to MELD score and beyond: Taking a walk down memory lane","volume":"27","author":"Ruf","year":"2022","journal-title":"Ann. 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