The ADOPT-LC score: a novel predictive index of in-hospital mortality of cirrhotic patients following surgical procedures, based on a national survey

Masaya Sato; Ryosuke Tateishi; Hideo Yasunaga; Hiromasa Horiguchi; Hiroki Matsui; Haruhiko Yoshida; Kiyohide Fushimi; Kazuhiko Koike

doi:10.1111/hepr.12719

The ADOPT-LC score: a novel predictive index of in-hospital mortality of cirrhotic patients following surgical procedures, based on a national survey

Hepatol Res. 2017 Mar;47(3):E35-E43. doi: 10.1111/hepr.12719. Epub 2016 May 6.

Authors

Masaya Sato^{1

2}, Ryosuke Tateishi¹, Hideo Yasunaga³, Hiromasa Horiguchi⁴, Hiroki Matsui³, Haruhiko Yoshida¹, Kiyohide Fushimi⁵, Kazuhiko Koike¹

Affiliations

¹ Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
² Department of Clinical Laboratory Medicine.
³ Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
⁴ Department of Clinical Data Management and Research, Clinical Research Center, National Hospital Organization Headquarters, Tokyo, Japan.
⁵ Department of Health Policy and Informatics, Tokyo Medical and Dental University, Graduate School of Medicine, Tokyo, Japan.

PMID: 27062144
DOI: 10.1111/hepr.12719

Abstract

Aim: We aimed to develop a model for predicting in-hospital mortality of cirrhotic patients following major surgical procedures using a large sample of patients derived from a Japanese nationwide administrative database.

Methods: We enrolled 2197 cirrhotic patients who underwent elective (n = 1973) or emergency (n = 224) surgery. We analyzed the risk factors for postoperative mortality and established a scoring system for predicting postoperative mortality in cirrhotic patients using a split-sample method.

Results: In-hospital mortality rates following elective or emergency surgery were 4.7% and 20.5%, respectively. In multivariate analysis, patient age, Child-Pugh (CP) class, Charlson Comorbidity Index (CCI), and duration of anesthesia in elective surgery were significantly associated with in-hospital mortality. In emergency surgery, CP class and duration of anesthesia were significant factors. Based on multivariate analysis in the training set (n = 987), the Adequate Operative Treatment for Liver Cirrhosis (ADOPT-LC) score that used patient age, CP class, CCI, and duration of anesthesia to predict in-hospital mortality following elective surgery was developed. This scoring system was validated in the testing set (n = 986) and produced an area under the curve of 0.881. We also developed iOS/Android apps to calculate ADOPT-LC scores to allow easy access to the current evidence in daily clinical practice.

Conclusion: Patient age, CP class, CCI, and duration of anesthesia were identified as important risk factors for predicting postoperative mortality in cirrhotic patients. The ADOPT-LC score effectively predicts in-hospital mortality following elective surgery and may assist decisions regarding surgical procedures in cirrhotic patients based on a quantitative risk assessment.

Keywords: ADOPT-LC; Child-Pugh score; in-hospital mortality; national database; scoring system.