Validation of current mortality risk prediction models in patients with cirrhosis undergoing cardiac surgery

Liver cirrhosis is a known risk factor for mortality after cardiac surgery. In this study, we investigated the correlation between existing prediction models and actual mortality rates after cardiac surgery.

Between July 2014 and December 2022, 1257 patients with a history of chronic liver disease underwent cardiac surgery, of whom 220 had a diagnosis of cirrhosis. Preoperative comorbidities, intraoperative details, and postoperative outcomes were analyzed. The Mayo Clinic and VOCAL-Penn scores were applied to the 220 patients and compared to observed mortality.

Among the 220 patients with cirrhosis, the preoperative median MELD score was 10. According to the Mayo Clinic score, the mean predicted mortality rate was 20.9% at 30 days and 29.6% at 90 days. In contrast, according to the VOCAL-Penn score, the mean predicted mortality rate was 9.0% at 30 days and 14.0% at 90 days, whereas the observed postoperative mortality of the 220 patients was 4.1% at 30 days and 12.6% at 90 days. VOCAL-Penn showed good calibration but still overestimated mortality by 3% at 30 days and by 1.3% at 90 days. The Mayo Clinic score demonstrated weak calibration, overestimating mortality by 15% at 30 days and by 17% at 90 days.

In this single-center analysis, the Mayo Clinic and VOCAL-Penn scores overestimated the postoperative mortality in patients with cirrhosis undergoing cardiac surgery, although VOCAL-Penn provided a more accurate risk prediction. Ultimately, this heterogeneous group of patients often presents with a wide range of comorbidities, which complicate risk stratification; however, patients should not be denied surgery solely on the basis of current risk prediction models.