In subgroup analyses of patients with higher MELD scores, the VOCAL-Penn had significantly higher C-statistics compared with the MELD and MELD-Na. The VOCAL-Penn had the lowest Brier score and highest IPA at both time points, suggesting superior overall predictive model performance. Calibrations were excellent for the VOCAL-Penn, MELD, and MELD-Na however, the Mayo score consistently overestimated risk. The VOCAL-Penn score had the numerically highest C-statistic for 90-day postoperative mortality (eg, 0.82 versus 0.79 Mayo versus 0.78 MELD-Na versus 0.79 MELD), although differences were not statistically significant. A total of 855 surgical procedures were identified. Concordance statistics (C-statistics), calibration curves, Brier scores, and the index of prediction accuracy (IPA) were compared for each predictive model. The outcomes of interest were 30-day and 90-day postoperative mortality. 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 January 1, 2008, to October 1, 2015. The goal of this study was to compare the predictive performance of the VOCAL-Penn to the Mayo risk, Model for End-Stage Liver Disease (MELD), and MELD-sodium (MELD-Na) scores in 2 large health systems. 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. doi:10.1038/s4139-9.Cirrhosis poses an increased risk of postoperative mortality, yet it remains challenging to accurately risk stratify patients in clinical practice. On-Treatment Improvement of MELD Score Reduces Death and Hepatic Events in Patients With Hepatitis B-Related Cirrhosis. Yip TC, Chan HL, Tse YK, Lam KL, Lui GC, Wong VW, et al. University of Wisconsin School of Medicine and Public Health. Model for End-stage Liver Disease (MELD) score and liver transplant: benefits and concerns. doi:10.2147/CEG.S160537Īiello FI, Bajo M, Marti F, Gadano A, Musso CG. Liver function tests in identifying patients with liver disease. Correction factor to improve agreement between point-of-care and laboratory International Normalized Ratio values. Johnson SA, Vazquez SR, Fleming R, Lanspa MJ. Analysis of mortality prognostic factors using model for end-stage liver disease with incorporation of serum-sodium classification for liver cirrhosis complications: A retrospective cohort study. The impact of cirrhosis and MELD score on postoperative morbidity and mortality among patients selected for liver resection. Zaydfudim VM, Turrentine FE, Smolkin ME, et al. Evaluation of model performance to predict survival after transjugular intrahepatic portosystemic shunt placement. Important predictor of mortality in patients with end-stage liver disease. Management of patients with liver diseases on the waiting list for transplantation: a major impact to the success of liver transplantation.
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