Risk factors and prediction model of reintubation after liver transplantation

doi:10.3877/cma.j.issn.1674-0793.2023.05.009

Abstract

Abstract:

Objective

To explore the risk factors of reintubation after liver transplantation, establish and validate prediction model, so as to provide reference for clinical practice.

Methods

A retrospective study was conducted in 500 patients who underwent liver transplantation in the First Affiliated Hospital of Sun Yat-sen University from January 2016 to December 2021. The selected patients were divided into reintubation group (Group R, 21 cases) and control group (Group C, 479 cases). The perioperative clinical data of the two groups were compared, and the risk factors and prognosis of reintubation after liver transplantation were analyzed.

Results

The incidence of reintubation in patients undergoing liver transplantation was 4.2% (21/500). Multivariate logistic regression analysis showed that high MELD score, elevated serum creatinine (Scr) 48 hours after operation, and alanine aminotransferase (ALT) peak value after operation were independent risk factors for reintubation after operation. The ROC curve was drawn for the above risk factors, and the area under the curve was 0.790 (95% CI: 0.677-0.903, P<0.001). The Nomogram prediction model of reintubation after liver transplantation was made, and the preliminary prediction of reintubation after liver transplantation was realized according to the score.

Conclusion

For patients undergoing liver transplantation, high MELD score before operation, increased Scr at 48 hours after operation, and peak ALT after operation are independent risk factors for reintubation after operation.

Key words: Liver transplantation, Reintubation, Postoperative, Risk factors, Retrospective, Predictive model

Kunhe Li, Mengjia Kou, Liting Kuang. Risk factors and prediction model of reintubation after liver transplantation[J]. Chinese Archives of General Surgery(Electronic Edition), 2023, 17(05): 366-371.

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References 24

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项目	C组	R组	统计值	P值
例数	479	21
年龄(岁)	52.12±10.87	50.76±10.91	0.558	0.577
性别^a			1.759	0.259
男	431(90.0)	17(81.0)
女	48(10.0)	4(19.0)
体质指数(kg/m²)	23.27±3.56	21.82±3.31	1.837	0.067
ASA分级^a			2.337	0.498
Ⅱ	43(9.0)	3(14.3)
Ⅲ	301(62.8)	10(47.6)
Ⅳ	135(28.2)	8(138.1)
MELD评分(分)	24.01±7.46	30.11±11.15	-3.582	0.022
MELD-Na评分(分)	24.31±7.56	29.95±11.29	-3.267	0.034
术前合并症^a
高血压病	69(14.4)	2(9.5)	0.393	0.753
糖尿病	69(14.4)	1(4.8)	1.554	0.336
肝硬化	345(72.0)	15(71.4)	0.004	0.952
肝衰竭	73(15.2)	9(42.9)	11.192	0.003
术前实验室检查
Hb(g/L)	114.97±29.03	105.05±32.02	1.526	0.128
PLT(×10⁹/L)^b	85.5(49,144)	83(56,182)	0.696	0.486
ALB(g/L)	36.89±5.46	36.67±6.08	0.180	0.857
TBIL(μmol/L)^b	29.2(17.1,102.4)	343.3(99.1,483.8)	2.310	0.021
ALT(U/L)^b	29.0(19.0，46.0)	52.0(45.0,104.0)	1.734	0.083
AST(U/L)^b	43.0(32.0,70.0)	142.0(65.0,222.0)	3.079	0.002
GGT(U/L)^b	66.5（36.0,122.5)	85.0(46.0,250.0)	0.864	0.387
LDH(U/L)^b	215.0(183.0,259.0)	270.0(209.0,286.0)	1.497	0.134

项目	C组	R组	统计值	P值
例数	479	21
年龄(岁)	52.12±10.87	50.76±10.91	0.558	0.577
性别^a			1.759	0.259
男	431(90.0)	17(81.0)
女	48(10.0)	4(19.0)
体质指数(kg/m²)	23.27±3.56	21.82±3.31	1.837	0.067
ASA分级^a			2.337	0.498
Ⅱ	43(9.0)	3(14.3)
Ⅲ	301(62.8)	10(47.6)
Ⅳ	135(28.2)	8(138.1)
MELD评分(分)	24.01±7.46	30.11±11.15	-3.582	0.022
MELD-Na评分(分)	24.31±7.56	29.95±11.29	-3.267	0.034
术前合并症^a
高血压病	69(14.4)	2(9.5)	0.393	0.753
糖尿病	69(14.4)	1(4.8)	1.554	0.336
肝硬化	345(72.0)	15(71.4)	0.004	0.952
肝衰竭	73(15.2)	9(42.9)	11.192	0.003
术前实验室检查
Hb(g/L)	114.97±29.03	105.05±32.02	1.526	0.128
PLT(×10⁹/L)^b	85.5(49,144)	83(56,182)	0.696	0.486
ALB(g/L)	36.89±5.46	36.67±6.08	0.180	0.857
TBIL(μmol/L)^b	29.2(17.1,102.4)	343.3(99.1,483.8)	2.310	0.021
ALT(U/L)^b	29.0(19.0，46.0)	52.0(45.0,104.0)	1.734	0.083
AST(U/L)^b	43.0(32.0,70.0)	142.0(65.0,222.0)	3.079	0.002
GGT(U/L)^b	66.5（36.0,122.5)	85.0(46.0,250.0)	0.864	0.387
LDH(U/L)^b	215.0(183.0,259.0)	270.0(209.0,286.0)	1.497	0.134

项目	C组	R组	统计值	P值
例数	479	21
手术时间(min)^a	451(394,520)	427(377,485)	0.590	0.555
阻断肝门时间(min)^a	54.0(44.5,65.0)	52.0(43.0,57.0)	0.360	0.719
阻断下腔时间(min)^a	49.0(40.0,57.0)	47.0(41.0,58.0)	0.057	0.954
术中出血量(ml)^a	1 500(800,2 500)	2 000(1 200,3 600)	2.107	0.035
输红细胞量(ml)^a	920(400,1 600)	1 550(600,3 600)	2.269	0.023
输血浆量(ml)^a	1 400(1 000,2 000)	1 600(1 000,2 800)	1.930	0.054
输冷沉淀(U)	5.71±7.84	6.29±8.11	-0.330	0.741
输血小板(U)	0.81±2.49	0.33±0.48	0.866	0.387

项目	C组	R组	统计值	P值
例数	479	21
手术时间(min)^a	451(394,520)	427(377,485)	0.590	0.555
阻断肝门时间(min)^a	54.0(44.5,65.0)	52.0(43.0,57.0)	0.360	0.719
阻断下腔时间(min)^a	49.0(40.0,57.0)	47.0(41.0,58.0)	0.057	0.954
术中出血量(ml)^a	1 500(800,2 500)	2 000(1 200,3 600)	2.107	0.035
输红细胞量(ml)^a	920(400,1 600)	1 550(600,3 600)	2.269	0.023
输血浆量(ml)^a	1 400(1 000,2 000)	1 600(1 000,2 800)	1.930	0.054
输冷沉淀(U)	5.71±7.84	6.29±8.11	-0.330	0.741
输血小板(U)	0.81±2.49	0.33±0.48	0.866	0.387

项目	C组	R组	Z值	P值
例数	479	21
术后48 h Scr (μmol/L)	79.0(64.0,99.5)	99.0(74.0,167.0)	-2.631	0.009
术后24 h PT (s)	17.2(15.4,20.1)	19.9(17.4,21.7)	-2.599	0.009
术后24 h INR	1.47(1.31,1.74)	1.78(1.55,1.91)	-2.688	0.007
术后24 h APTT (s)	50.1(41.0,61.8)	62.1(55.0,73.0)	-3.814	<0.001
术后24 h FIB(g/L)	1.69(1.35,2.07)	1.35(1.25,1.63)	-3.014	0.003
术后24 h血氨(μmol/L)	32.0(21.0，47.0)	49.0(33.0,60.0)	-2.507	0.012
术后ALT峰值(U/L)	623(327,976)	782(452,1183)	-2.227	0.026
术后AST峰值(U/L)	1243(737,2223)	1850(1356,2778)	-3.141	0.002

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