Canillas Lidia, Pelegrina Amalia, Colominas-González Elena, Salis Aina, Enríquez-Rodríguez César J, Duran Xavier, Caro Antonia, Álvarez Juan, Carrión José A
Department of Medicine and Life Sciences, Universitat Pompeu Fabra, 08003 Barcelona, Spain.
Liver Section, Gastroenterology Department, Hospital del Mar, 08003 Barcelona, Spain.
J Clin Med. 2023 Sep 21;12(18):6100. doi: 10.3390/jcm12186100.
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. This is a retrospective, observational study to evaluate the predictive capacity of surgical risk scores in European patients with ACLD. Cirrhosis was defined by the presence of thrombocytopenia with <150,000/uL and splenomegaly, and AST-to-Platelet Ratio Index >2, a nodular liver edge seen via ultrasound, transient elastography of >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 the H. Mar and VOCAL-Penn cohorts were identified. Etiology, obesity, and platelet count were not associated with mortality. The VOCAL-Penn showed the best discrimination (C-statistic = 0.876) and overall predictive capacity (Brier = 0.054), but calibration was not excellent in our cohort. VOCAL-Penn was suboptimal in patients with diabetes (C-statistic = 0.770), without signs of portal hypertension (C-statistic = 0.555), or with abdominal wall (C-statistic = 0.608) or urgent (C-statistic = 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.
与普通人群相比，患有晚期慢性肝病（ACLD）或肝硬化且接受手术的患者发生并发症和死亡的风险更高。这是一项回顾性观察研究，旨在评估手术风险评分对欧洲ACLD患者的预测能力。肝硬化的定义为血小板减少（<150,000/μL）伴脾肿大、AST与血小板比值指数>2、超声检查可见肝脏边缘呈结节状、瞬时弹性成像结果>15 kPa和/或门静脉高压体征。我们评估了与90天死亡率相关的变量以及当前手术评分（Child-Pugh、MELD-Na、MRS、NSQIP和VOCAL-Penn）的辨别力和校准情况。仅纳入了VOCAL-Penn中包含的ACLD和大手术患者（n = 512）。术后90天的死亡率为9.8%。确定了H. Mar队列和VOCAL-Penn队列之间的基线差异。病因、肥胖和血小板计数与死亡率无关。VOCAL-Penn表现出最佳的辨别力（C统计量 = 0.876）和总体预测能力（Brier值 = 0.054），但在我们的队列中校准效果并不理想。VOCAL-Penn在糖尿病患者（C统计量 = 0.770）、无门静脉高压体征的患者（C统计量 = 0.555）、腹壁手术患者（C统计量 = 0.608）或急诊手术患者（C统计量 = 0.692）中表现欠佳。我们的欧洲队列显示术后死亡率与美国研究中描述的相似。然而，VOCAL-Penn评分中包含的一些变量与死亡率无关，并且在糖尿病患者、无门静脉高压体征的患者以及腹壁手术或急诊手术患者中，VOCAL-Penn的辨别能力会降低。这些结果应在更大规模的多中心前瞻性研究中得到验证。
