ArticleClinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association2022
Risk Prediction Models for Postoperative Decompensation and Infection in Patients With Cirrhosis: A Veterans Affairs Cohort Study.
Article in Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers.
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Who cites it
18 citing papers in PubMed, 34 citations in OpenAlex.
- Validation of current mortality risk prediction models in patients with cirrhosis undergoing cardiac surgery.JTCVS open · 2026Article
- Risk of bleeding after esophagogastroduodenoscopy with mucosal resection in patients with cirrhosis.Surgical endoscopy · 2026Article
- Five essential features for adoption of clinical risk prediction tools: Insights from the VOCAL-Penn score.Hepatology communications · 2025Article
- Acute-on-chronic liver failure.BJA education · 2025Review
- Clinical Ascites and Emergency Procedure as Determinants of Surgical Risk in Patients with Advanced Chronic Liver Disease.Journal of clinical medicine · 2025Article
- High Cirrhosis Surgical Volume Centers Have Reduced Postoperative Mortality in Patients With Cirrhosis Undergoing Major Surgery.The American journal of gastroenterology · 2025Article
- Pre-Operative Assessment of Patients with Cirrhosis for Extrahepatic Surgery.Current hepatology reports · 2025Review
- Recent TIPS increases postoperative mortality: A national cohort study.Hepatology communications · 2024Article
- Preoperative Hepatology and Primary Care Visits Improve Postoperative Outcomes in Patients With Cirrhosis Undergoing Surgery.Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association · 2024Article
- Artificial intelligence-based evaluation of prognosis in cirrhosis.Journal of translational medicine · 2024Review
- Surgical risk stratification in patients with cirrhosis.Hepatology international · 2024Review
- Preoperative risk evaluation and optimization for patients with liver disease.Gastroenterology report · 2024Review
- The clinician's dilemma with spontaneous bacterial empyema.Clinical liver disease · 2023Article
- Evolution of risk prediction models for post-operative mortality in patients with cirrhosis.Hepatology international · 2023Article
- Clinical Guideline on Perioperative Management of Patients with Advanced Chronic Liver Disease.Life (Basel, Switzerland) · 2023Review
- Liver Transplantation for Primary Sclerosing Cholangitis (PSC) With or Without Inflammatory Bowel Disease (IBD)-A European Society of Organ Transplantation (ESOT) Consensus Statement.Transplant international : official journal of the European Society for Organ Transplantation · 2023Article
- Performance of risk prediction models for post-operative mortality in patients undergoing liver resection.American journal of surgery · 2023Article
- Modeling Optimal Clinical Thresholds for Elective Abdominal Hernia Repair in Patients With Cirrhosis.JAMA network open · 2022Article
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Authors and funding
6 authors at 5 institutions in 1 country.
Funding
Abstract
BACKGROUND AND
aimsPatients with cirrhosis have an increased risk of postoperative mortality for a range of surgeries; however, they are also at risk of postoperative complications such as infection and cirrhosis decompensation. To date, there are no prediction scores that specifically risk stratify patients for these morbidities.
methodsThis was a retrospective study using data of patients with cirrhosis who underwent diverse surgeries in the Veterans Health Administration. Validated algorithms and/or manual adjudication were used to ascertain postoperative decompensation and postoperative infection through 90 days. Multivariable logistic regression was used to evaluate prediction models in derivation and validation sets using variables from the recently-published Veterans Outcomes and Costs Associated with Liver Disease (VOCAL)-Penn cirrhosis surgical risk scores for postoperative mortality. Models were compared with the Mayo risk score, Model for End-stage Liver Disease (MELD)-sodium, and Child-Turcotte-Pugh (CTP) scores.
resultsA total 4712 surgeries were included; patients were predominantly male (97.2 %), white (63.3 %), and with alcohol-related liver disease (35.3 %). Through 90 postoperative days, 8.7 % of patients experienced interval decompensation, and 4.5 % infection. Novel VOCAL-Penn prediction models for decompensation demonstrated good discrimination for interval decompensation (C-statistic 0.762 vs 0.663 Mayo vs 0.603 MELD-sodium vs 0.560 CTP; P < .001); however, discrimination was only fair for postoperative infection (C-statistic 0.666 vs 0.592 Mayo [P = .13] vs 0.502 MELD-sodium [P < .001] vs 0.503 CTP [P < .001]). The model for interval decompensation had excellent calibration in both derivation and validation sets.
conclusionWe report the derivation and internal validation of a novel, parsimonious prediction model for postoperative decompensation in patients with cirrhosis. This score demonstrated superior discrimination and calibration as compared with existing clinical standards, and will be available at www.vocalpennscore.com.
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