Risk Prediction Models for Post-Operative Mortality in Patients With Cirrhosis.
Risk Prediction Models for Post-Operative Mortality in Patients With Cirrhosis.
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DOI：
10.1002/hep.31558
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发表时间：
2021-01
期刊：
影响因子：
--
通讯作者：
Kaplan DE
中科院分区：
文献类型：
--
作者：
Mahmud N;Fricker Z;Hubbard RA;Ioannou GN;Lewis JD;Taddei TH;Rothstein KD;Serper M;Goldberg DS;Kaplan DE
肝硬化患者术后死亡风险增加。目前可用于预测术后风险的工具校准不佳，且未考虑手术类型。我们的目标是使用人群水平的数据来推导和内部验证新的肝硬化手术风险模型。我们进行了一项回顾性队列研究，使用来自退伍军人肝脏疾病相关结局和费用（VOCAL）队列的数据，其中包含来自128个美国医疗中心的肝硬化患者的颗粒数据，与退伍军人事务部手术质量改进计划（VASQIP）合并，以确定手术程序。我们将手术分类为腹壁、血管、腹部、心脏、胸部或整形外科，并使用多变量logistic回归对术后30、90和180天死亡率进行建模（VOCAL-Penn模型）。我们将VOCAL-Penn的模型区分和校准与马约风险评分（MRS）、MELD、MELD-Na和Child-Turcotte-Pugh（CTP）评分进行了比较。我们在3,785例肝硬化患者中确定了4,712例外科手术。新的VOCAL-Penn模型被推导出来并进行了内部验证，具有良好的区分度（30天术后死亡率C-统计量=0.859，95%置信区间[CI] 0.809-0.909）。预测因素包括年龄、术前白蛋白、血小板计数、胆红素、手术类别、急诊指征、脂肪肝疾病、美国麻醉医师协会分级和肥胖。在辨别力和校准方面，模型性能在所有时间点均上级MELD、MELD-Na、CTP和MRS（例如，MRS的术后30天死亡率C统计量=0.766，95% CI 0.676-0.855）。VOCAL-Penn模型显著改善了肝硬化患者的术后死亡率预测。这些模型可以在实践中应用，以改善术前风险分层和优化患者选择外科手术（www.vocalpennscore.com）。
Patients with cirrhosis are at increased risk of post-operative mortality. Currently available tools to predict post-operative risk are suboptimally calibrated and do not account for surgery type. Our objective was to use population-level data to derive and internally validate novel cirrhosis surgical risk models. We conducted a retrospective cohort study using data from the Veterans Outcomes and Costs Associated with Liver Disease (VOCAL) cohort, which contains granular data on patients with cirrhosis from 128 United States medical centers, merged with the Veterans Affairs Surgical Quality Improvement Program (VASQIP) to identify surgical procedures. We categorized surgeries as abdominal wall, vascular, abdominal, cardiac, chest, or orthopedic, and used multivariable logistic regression to model 30, 90, and 180-day post-operative mortality (VOCAL-Penn models). We compared model discrimination and calibration of VOCAL-Penn to the Mayo risk score (MRS), MELD, MELD-Na, and Child-Turcotte-Pugh (CTP) scores. We identified 4,712 surgical procedures in 3,785 patients with cirrhosis. The novel VOCAL-Penn models were derived and internally validated with excellent discrimination (30-day post-operative mortality C-statistic=0.859, 95% confidence interval [CI] 0.809–0.909). Predictors included age, pre-operative albumin, platelet count, bilirubin, surgery category, emergency indication, fatty liver disease, American Society of Anesthesiologists classification, and obesity. Model performance was superior to MELD, MELD-Na, CTP, and MRS at all timepoints (e.g. 30-day post-operative mortality C-statistic for MRS=0.766, 95% CI 0.676–0.855) in terms of discrimination and calibration. The VOCAL-Penn models substantially improve post-operative mortality predictions in patients with cirrhosis. These models may be applied in practice to improve pre-operative risk stratification and optimize patient selection for surgical procedures (www.vocalpennscore.com).
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影响因子：
6.7
作者：
Karagozian, Raffi;Bhardwaj, Gaurav;Baffy, Gyorgy
通讯作者：
Baffy, Gyorgy
2001-2013 年美国退伍军人肝硬化和肝细胞癌负担趋势（按肝脏疾病分类
影响因子：
29.4
作者：
Beste, Lauren A.;Leipertz, Steven L.;Ioannou, George N.
通讯作者：
Ioannou, George N.
影响因子：
168.9
作者：
Mack, Michael J.;Leon, Martin B.;Svensson, Lars G.
通讯作者：
Svensson, Lars G.
影响因子：
4.3
作者：
Hoteit, Maarouf A.;Ghazale, Amaar H.;Rutherford, Robin E.
通讯作者：
Rutherford, Robin E.
DOI：
10.1016/j.jamcollsurg.2007.01.012
发表时间：
2007-04-01
影响因子：
5.2
作者：
Davis, Chester L.;Pierce, John R.;Booker, Brigitte
通讯作者：
Booker, Brigitte