Canillas, L.; Pelegrina, A.; Colominas-González, E.; Salis, A.; Enríquez-Rodríguez, C.J.; Duran, X.; Caro, A.; Álvarez, J.; Carrión, J.A. Comparison of Surgical Risk Scores in a European Cohort of Patients with Advanced Chronic Liver Disease. J. Clin. Med.2023, 12, 6100.
Canillas, L.; Pelegrina, A.; Colominas-González, E.; Salis, A.; Enríquez-Rodríguez, C.J.; Duran, X.; Caro, A.; Álvarez, J.; Carrión, J.A. Comparison of Surgical Risk Scores in a European Cohort of Patients with Advanced Chronic Liver Disease. J. Clin. Med. 2023, 12, 6100.
Canillas, L.; Pelegrina, A.; Colominas-González, E.; Salis, A.; Enríquez-Rodríguez, C.J.; Duran, X.; Caro, A.; Álvarez, J.; Carrión, J.A. Comparison of Surgical Risk Scores in a European Cohort of Patients with Advanced Chronic Liver Disease. J. Clin. Med.2023, 12, 6100.
Canillas, L.; Pelegrina, A.; Colominas-González, E.; Salis, A.; Enríquez-Rodríguez, C.J.; Duran, X.; Caro, A.; Álvarez, J.; Carrión, J.A. Comparison of Surgical Risk Scores in a European Cohort of Patients with Advanced Chronic Liver Disease. J. Clin. Med. 2023, 12, 6100.
Abstract
Patients with advanced chronic liver disease (ACLD) or cirrhosis undergoing surgery have an increased risk of morbidity and mortality in contrast to the general population. Retrospective, observational study of ACLD patients to evaluate the predictive capacity of previous surgical risk scores in a European cohort of patients. ACLD was defined by the presence of thrombocytopenia <150.000/uL and splenomegaly; AST-to-Platelet Ratio Index >2; nodular liver edge by ultrasound; transient elastography >15 kPa and/or signs of portal hypertension. We assessed variables related to 90-day mortality and the discrimination and calibration of current surgical scores (Child-Pugh, MELD-Na, MRS, NSQIP, and VOCAL-Penn). Only patients with ACLD and major surgeries included in VOCAL-Penn were considered (n=512). The mortality rate at 90 days after surgery was 9.8%. Baseline disparities between H. Mar and VOCAL-Penn cohorts were identified. Etiology, obesity, or platelet count not were associated with mortality. The VOCAL-Penn showed the best discrimination (C-statistic90D= 0.876) and overall predictive capacity (Brier90D= 0.054) but calibration was not excellent in our cohort. VOCAL-Penn was suboptimal in patients with diabetes (C-statistic30D= 0.770), without signs of portal hypertension (C-statistic30D= 0.555), or with an abdominal wall (C-statistic30D= 0.608) or urgent (C-statistic180D= 0.692) surgeries. Our European cohort has shown a mortality rate after surgery similar to those described in American studies. However, some variables included in the VOCAL-Penn score were not associated with mortality, and VOCAL-Penn’s discriminative ability decreases in patients with diabetes, without signs of portal hypertension, and with abdominal wall or urgent surgeries. These results should be validated in larger multicenter and prospective studies.
Medicine and Pharmacology, Gastroenterology and Hepatology
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