{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T06:09:59Z","timestamp":1772518199185,"version":"3.50.1"},"reference-count":28,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2023,9,21]],"date-time":"2023-09-21T00:00:00Z","timestamp":1695254400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Programa de Qualitat del Parc de Salut Mar"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Patients with advanced chronic liver disease (ACLD) or cirrhosis undergoing surgery have an increased risk of morbidity and mortality in contrast to the general population. This is a retrospective, observational study to evaluate the predictive capacity of surgical risk scores in European patients with ACLD. Cirrhosis was defined by the presence of thrombocytopenia with &lt;150,000\/uL and splenomegaly, and AST-to-Platelet Ratio Index &gt;2, a nodular liver edge seen via ultrasound, transient elastography of &gt;15 kPa, and\/or signs of portal hypertension. We assessed variables related to 90-day mortality and the discrimination and calibration of current surgical scores (Child-Pugh, MELD-Na, MRS, NSQIP, and VOCAL-Penn). Only patients with ACLD and major surgeries included in VOCAL-Penn were considered (n = 512). The mortality rate at 90 days after surgery was 9.8%. Baseline disparities between the H. Mar and VOCAL-Penn cohorts were identified. Etiology, obesity, and platelet count were not associated with mortality. The VOCAL-Penn showed the best discrimination (C-statistic90D = 0.876) and overall predictive capacity (Brier90D = 0.054), but calibration was not excellent in our cohort. VOCAL-Penn was suboptimal in patients with diabetes (C-statistic30D = 0.770), without signs of portal hypertension (C-statistic30D = 0.555), or with abdominal wall (C-statistic30D = 0.608) or urgent (C-statistic180D = 0.692) surgeries. Our European cohort has shown a mortality rate after surgery similar to those described in American studies. However, some variables included in the VOCAL-Penn score were not associated with mortality, and VOCAL-Penn\u2019s discriminative ability decreases in patients with diabetes, without signs of portal hypertension, and with abdominal wall or urgent surgeries. These results should be validated in larger multicenter and prospective studies.<\/jats:p>","DOI":"10.3390\/jcm12186100","type":"journal-article","created":{"date-parts":[[2023,9,21]],"date-time":"2023-09-21T21:16:49Z","timestamp":1695331009000},"page":"6100","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Comparison of Surgical Risk Scores in a European Cohort of Patients with Advanced Chronic Liver Disease"],"prefix":"10.3390","volume":"12","author":[{"given":"Lidia","family":"Canillas","sequence":"first","affiliation":[{"name":"Department of Medicine and Life Sciences, Universitat Pompeu Fabra, 08003 Barcelona, Spain"},{"name":"Liver Section, Gastroenterology Department, Hospital del Mar, 08003 Barcelona, Spain"},{"name":"Hospital del Mar Medical Research Institute, 08003 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amalia","family":"Pelegrina","sequence":"additional","affiliation":[{"name":"Department of Medicine and Life Sciences, Universitat Pompeu Fabra, 08003 Barcelona, Spain"},{"name":"Hospital del Mar Medical Research Institute, 08003 Barcelona, Spain"},{"name":"Department of General Surgery, Hospital del Mar, 08003 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6835-2868","authenticated-orcid":false,"given":"Elena","family":"Colominas-Gonz\u00e1lez","sequence":"additional","affiliation":[{"name":"Department of Medicine and Life Sciences, Universitat Pompeu Fabra, 08003 Barcelona, Spain"},{"name":"Pharmacy Department, Hospital del Mar, 08003 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aina","family":"Salis","sequence":"additional","affiliation":[{"name":"Department of Medicine and Life Sciences, Universitat Pompeu Fabra, 08003 Barcelona, Spain"},{"name":"Department of Medicine, Universitat Aut\u00f2noma de Barcelona, 08003 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C\u00e9sar J.","family":"Enr\u00edquez-Rodr\u00edguez","sequence":"additional","affiliation":[{"name":"Department of Medicine and Life Sciences, Universitat Pompeu Fabra, 08003 Barcelona, Spain"},{"name":"Hospital del Mar Medical Research Institute, 08003 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xavier","family":"Duran","sequence":"additional","affiliation":[{"name":"Biostatistics Unit, Hospital del Mar Research Institute, 08003 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antonia","family":"Caro","sequence":"additional","affiliation":[{"name":"Liver Section, Gastroenterology Department, Hospital del Mar, 08003 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juan","family":"\u00c1lvarez","sequence":"additional","affiliation":[{"name":"Hospital del Mar Medical Research Institute, 08003 Barcelona, Spain"},{"name":"Anesthesia Department, Hospital del Mar, 08003 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7191-6081","authenticated-orcid":false,"given":"Jos\u00e9 A.","family":"Carri\u00f3n","sequence":"additional","affiliation":[{"name":"Department of Medicine and Life Sciences, Universitat Pompeu Fabra, 08003 Barcelona, Spain"},{"name":"Liver Section, Gastroenterology Department, Hospital del Mar, 08003 Barcelona, Spain"},{"name":"Hospital del Mar Medical Research Institute, 08003 Barcelona, Spain"},{"name":"Department of Medicine, Universitat Aut\u00f2noma de Barcelona, 08003 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,9,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e345","DOI":"10.1097\/SLA.0000000000003674","article-title":"Incidence and Risk Factors of Postoperative Mortality and Morbidity after Elective Versus Emergent Abdominal Surgery in a National Sample of 8193 Patients with Cirrhosis","volume":"274","author":"Johnson","year":"2021","journal-title":"Ann. 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