Blacktown Clinical School, School of Medicine, Western Sydney University, Blacktown, NSW, 2148, Australia.
Storr Liver Centre, The Westmead Institute for Medical Research, Westmead Hospital and University of Sydney, Westmead, NSW, 2145, Australia.
Hepatol Int. 2023 Jun;17(3):542-545. doi: 10.1007/s12072-023-10494-0. Epub 2023 Mar 27.
The perception of high surgical risk among patients with cirrhosis has resulted in a long-standing reluctance to operate. Risk stratification tools, first implemented over 60 years ago, have attempted to assess mortality risk among cirrhotic patients and ensure the best possible outcomes for this difficult to treat cohort. Existing postoperative risk prediction tools including the Child-Turcotte-Pugh (CTP) and Model for End-stage Liver Disease (MELD) provide some prediction of risk in counselling patients and their families but tend to overestimate surgical risk. More personalised prediction algorithms such as the Mayo Risk Score and VOCAL-Penn score that incorporate surgery-specific risks have demonstrated a significant improvement in prognostication and can ultimately aid multidisciplinary team determination of potential risks. The development of future risk scores will need to incorporate, first and foremost, predictive efficacy, but perhaps just as important is the feasibility and usability by front-line healthcare professionals to ensure timely and efficient prediction of risk for cirrhotic patients.
肝硬化患者对高手术风险的认知导致长期以来不愿进行手术。风险分层工具早在 60 多年前就已实施，旨在评估肝硬化患者的死亡率，并为这一治疗困难的患者群体确保最佳治疗效果。现有的术后风险预测工具包括 Child-Turcotte-Pugh（CTP）和终末期肝病模型（MELD），为患者及其家属提供了一定的风险预测，但往往高估了手术风险。更个性化的预测算法，如 Mayo 风险评分和 VOCAL-Penn 评分，纳入了手术特定风险，显著提高了预后预测能力，最终有助于多学科团队确定潜在风险。未来风险评分的开发首先需要考虑预测效果，但同样重要的是一线医疗保健专业人员的可行性和可用性，以确保及时、有效地预测肝硬化患者的风险。
