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.

中文翻译：

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肝切除后基于评分的90天死亡率预测的比较。

背景技术用于肝外科手术的适应症正在迅速扩大并且手术的复杂性增加。通过评分系统进行术前死亡风险评估尚有争议。先前发布的外部验证的死亡率风险评分可以轻松，准确地预测术后死亡率。该研究的目的是比较死亡率风险得分与标准得分MELD和P-POSSUM的表现。方法分析529例肝切除患者的资料。计算了死亡率风险评分，labMELD评分和P-POSSUM评分（PS，OS，P-POSSUM死亡率％）。使用logistic回归模型计算了三个评分系统的ROC曲线，并计算了曲线下的面积（C指数）。使用相应的Wald检验对ROC曲线进行比较。结果内部验证证实该风险模型可预测90天死亡率，C指数为0.8421。labMELD得分的C指数为0.7352，P-POSSUM系统为0.6795（PS 0.6953，操作系统0.5413）。90天死亡率随着labMELD值的增加而增加（p <0.0001）。根据死亡率风险得分组分类，labMELD得分显示线性增长，而POSSUM得分显示变化的结果。结论通过准确预测肝脏手术后的术后死亡风险，死亡率风险评分在选择阶段应是有用的。可以通过使用公认的labMELD分数​​来调整预测。相反，标准P-POSSUM分数的性能是有限的。