Comparison of score-based prediction of 90-day mortality after liver resection

Abstract

Background: Indications for liver surgery are expanding fast and complexity of procedures increases. Preoperative mortality risk assessment by scoring systems is debatable. A previously published externally validated Mortality Risk Score allowed easy applicable and precise prediction of postoperative mortality. Aim of the study was to compare the performance of the Mortality Risk Score with the standard scores MELD and P-POSSUM. Methods: Data of 529 patients undergoing liver resection were analysed. Mortality Risk Score, the labMELD Score and the P-POSSUM Scores (PS, OS, P-POSSUM mortality %) were calculated. The ROC curves of the three scoring systems were computed and the areas under the curve (C-index) were calculated using logistic regression models. Comparisons between the ROC curves were performed using the corresponding Wald tests. Results: Internal validation confirmed that the risk model was predictive for a 90-day mortality rate with a C-index of 0.8421. The labMELD Score had a C-index of 0.7352 and the P-POSSUM system 0.6795 (PS 0.6953, OS 0.5413). The 90-day mortality rate increased with increasing labMELD values (p < 0.0001). Categorized according to the Mortality Risk Score Groups the labMELD Score showed a linear increase while the POSSUM Scores showed variable results. Conclusions: By accurately predicting the risk of postoperative mortality after liver surgery the Mortality Risk Score should be useful at the selection stage. Prediction can be adjusted by use of the well-established labMELD Score. In contrast, the performance of standard P-POSSUM Scores is limited.

An Improved Scoring System Based on Platelet-Albumin-Bilirubin in Predicting Posthepatectomy Liver Failure Outcomes

“…Compared with the Child-Turcotte-Pugh score, the MELD score was not subject to the subjective influence of ascites and hepatic encephalopathy, and the results were more objective. In addition, MELD can be used to evaluate the survival rate of hepatocellular carcinoma (HCC) patients and surgical risk of patients with cirrhosis [4][5][6][7]. But the reference range of the MELD score is ambiguous, especially in the case of ascites, hepatic encephalopathy, hemorrhage, and Dig Dis 2021;39:258-265 DOI: 10.1159/000511138 other complications in patients with cirrhosis, and the accuracy of prediction is poor [6].…”

Perioperative screening and management in elective complex hepatobiliary surgery

“…The MELD has been validated as a score in predicting mortality in patients with liver disease undergoing surgery. Literature suggests that the 30-day mortality increased by 1% for escalating MELD scores between 6 and 20, and an additional 2% per point for scores above 20 [21,22].…”

“…A significantly higher risk of PHLF is observed in patients demonstrating 5% or less FLR hypertrophy after embolization [2,3 ▪ ,11 ▪ ,30 ▪ ,37]. Systemic reviews and meta-analyses have shown that patients undergoing resection after PVE demonstrated a significantly lower incidence of PHLF and death in these patients compared with series reporting outcomes after major hepatectomy without PVE [5 ▪▪ ,22,28 ▪▪ ,30 ▪ ,37].…”

Predictors of 90-Day Mortality following Hepatic Resection for Hepatocellular Carcinoma

“…Furthermore, many authors validate their data with existing scoring systems, which were either not designed exclusively for HR in the first place or derived from different patient profiles [11][12][13]. Hence there is a paucity of data with regard to variables predicting 90-day mortality following elective HR for HCC.…”