External Validation of the VOCAL-Penn Cirrhosis Surgical Risk Score in 2 Large, Independent Health Systems.
External Validation of the VOCAL-Penn Cirrhosis Surgical Risk Score in 2 Large, Independent Health Systems.
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VOCAL-Penn 肝硬化手术风险评分在 2 个大型独立卫生系统的外部验证。
DOI：
10.1002/lt.26060
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发表时间：
2021-07
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;Panchal S;Lewis JD;Goldberg DS;Kaplan DE
肝硬化会增加术后死亡的风险，但在临床实践中准确对患者进行风险分层仍然具有挑战性。 VOCAL-Penn 肝硬化手术风险评分最近在国家退伍军人事务部卫生系统中开发并进行了内部验证，但迄今为止，该评分尚未在独立队列中进行评估。本研究的目的是比较 VOCAL-Penn 与梅奥风险、终末期肝病 (MELD) 模型以及两个大型卫生系统中 MELD-钠 (MELD-Na) 评分的预测性能。我们对 2008 年 1 月 1 日至 2015 年 10 月 1 日在贝斯以色列女执事医疗中心或宾夕法尼亚大学卫生系统接受相关外科手术的肝硬化患者进行了一项回顾性队列研究。感兴趣的结果是术后 30 天和 90 天的死亡率。对每个预测模型的 C 统计量、校准曲线、Brier 分数和预测准确性指数 (IPA) 进行了比较。总共确定了 855 例外科手术。 VOCAL-Penn 评分在术后 90 天的死亡率中具有最高的 C 统计量（例如，0.82 vs. 0.79 Mayo vs. 0.78 MELD-Na vs. 0.79 MELD），但差异不具有统计学意义。 VOCAL-Penn、MELD 和 MELD-Na 的校准效果非常好，但 Mayo 评分始终高估了风险。 VOCAL-Penn 在两个时间点的 Brier 得分最低，IPA 最高，表明整体预测模型性能优越。在较高 MELD 患者的亚组分析中，VOCAL-Penn 的 C 统计量显着高于 MELD 和 MELD-Na。 VOCAL-Penn 评分 (www.vocalpennscore.com) 对不同肝硬化患者的术后死亡率具有出色的辨别力和校准能力。整体表现优于 Mayo、MELD 和 MELD-Na 评分。与 MELD/MELD-Na 相比，VOCAL-Penn 在较高 MELD 患者中保留了出色的辨别力。
Cirrhosis poses an increased risk of post-operative mortality, however it remains challenging to accurately risk stratify patients in clinical practice. The VOCAL-Penn cirrhosis surgical risk score was recently developed and internally validated in the national Veterans Affairs health system, however to date this score has not been evaluated in independent cohorts. The goal of this study was to compare the predictive performance of VOCAL-Penn to the Mayo risk, model for end-stage liver disease (MELD), and MELD-sodium (MELD-Na) scores in two large health systems. We performed a retrospective cohort study of patients with cirrhosis undergoing surgical procedures of interest at the Beth Israel Deaconess Medical Center or University of Pennsylvania Health System from 1/1/2008–10/1/2015. The outcomes of interest were 30- and 90-day post-operative mortality. C-statistics, calibration curves, Brier scores, and the index of prediction accuracy (IPA) were compared for each predictive model. A total 855 surgical procedures were identified. The VOCAL-Penn score had the numerically highest C-statistic through 90 days post-operative mortality, (e.g., 0.82 vs. 0.79 Mayo vs. 0.78 MELD-Na vs. 0.79 MELD), though differences were not statistically significant. Calibration was excellent for VOCAL-Penn, MELD, and MELD-Na, however the Mayo score consistently overestimated risk. VOCAL-Penn had the lowest Brier score and highest IPA at both timepoints, suggesting superior overall predictive model performance. In subgroup analyses of higher-MELD patients, VOCAL-Penn had significantly higher C-statistics as compared to MELD and MELD-Na. The VOCAL-Penn score (www.vocalpennscore.com) has excellent discrimination and calibration for post-operative mortality among diverse patients with cirrhosis. Overall performance is superior to Mayo, MELD, and MELD-Na scores. In contrast to MELD/MELD-Na, VOCAL-Penn retains excellent discrimination among higher MELD patients.
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DOI：
10.1002/hep.31558
发表时间：
2021-01
期刊：
Hepatology (Baltimore, Md.)
影响因子：
--
作者：
Mahmud N;Fricker Z;Hubbard RA;Ioannou GN;Lewis JD;Taddei TH;Rothstein KD;Serper M;Goldberg DS;Kaplan DE
通讯作者：
Kaplan DE
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：
39.2
作者：
Collins, Gary S.;Reitsma, Johannes B.;Moons, Karel G. M.
通讯作者：
Moons, Karel G. M.
影响因子：
3.8
作者：
Zhang, Ye;Ou, De-hua;Lin, Ming-en
通讯作者：
Lin, Ming-en
影响因子：
3.7
作者：
Philip, George;Djerboua, Maya;Flemming, Jennifer A.
通讯作者：
Flemming, Jennifer A.