Kanwal Fasiha, Chen David, Ting Lena, Gornbein Jeffrey, Saab Sammy, Durazo Francisco, Yersiz Hasan, Farmer Douglas, Ghobrial R Mark, Busuttil Ronald W, Han Steven-Huy
Division of Digestive Diseases, David Geffen School of Medicine at University of California at Los Angeles, CA, USA.
Liver Transpl. 2003 Dec;9(12):1312-9. doi: 10.1016/j.lts.2003.09.023.
Postoperative mental status changes are common after liver transplantation (LT). A clear cause of these mental status changes cannot be identified in a significant proportion of patients. In adult liver transplant recipients, our goals are to: (1) identify independent predictors for the development of post-LT mental status changes of unclear cause and (2) derive a practical formula to predict the risk for developing this complication by using simple clinical parameters. Eligible patients had documented mental status changes of at least 3 days' duration, occurring within 1 month of LT. Exclusion criteria were known structural brain disorders, major organ dysfunction, or metabolic causes of altered mentation. Age- and sex-matched controls were liver transplant recipients without post-LT neurological sequelae. Data were collected on preoperative, intraoperative, and postoperative variables. Univariate and multivariate analyses were performed to detect factors predictive of the development of post-LT mental status of unclear cause. There were 40 cases and 40 controls. Independent predictors of mental status changes of unclear cause included alcoholic and metabolic liver diseases; pre-LT mechanical ventilation; Model for End-Stage Liver Disease (MELD) score greater than 15; and nonelective LT. Using these four preoperative factors, a simple predictive rule was developed. Risk for developing altered mental status of unclear cause after LT was 78% to 89% if all four predictors were present versus 0.8% to 2.4% if no predictors were present. In conclusion, alcoholic and metabolic liver diseases, pre-LT mechanical ventilation, MELD score greater than 15, and nonelective LT are independent predictive factors for post-LT altered mental status changes of unclear cause. A simple model can be used to calculate the risk for developing altered mental status post-LT.
肝移植（LT）术后精神状态改变很常见。在相当一部分患者中，无法明确这些精神状态改变的原因。对于成年肝移植受者，我们的目标是：（1）确定不明原因的肝移植术后精神状态改变发生的独立预测因素；（2）通过使用简单的临床参数得出一个实用公式来预测发生这种并发症的风险。符合条件的患者有记录在案的精神状态改变，持续至少3天，发生在肝移植后1个月内。排除标准为已知的结构性脑部疾病、主要器官功能障碍或导致精神状态改变的代谢原因。年龄和性别匹配的对照组为没有肝移植术后神经后遗症的肝移植受者。收集术前、术中和术后变量的数据。进行单因素和多因素分析以检测预测不明原因的肝移植术后精神状态改变发生的因素。有40例病例和40例对照。不明原因的精神状态改变的独立预测因素包括酒精性和代谢性肝病；肝移植前机械通气；终末期肝病模型（MELD）评分大于15；以及非择期肝移植。使用这四个术前因素，制定了一个简单的预测规则。如果所有四个预测因素都存在，肝移植后发生不明原因的精神状态改变的风险为78%至89%，而如果没有预测因素，则为0.8%至2.4%。总之，酒精性和代谢性肝病、肝移植前机械通气、MELD评分大于15以及非择期肝移植是不明原因的肝移植术后精神状态改变的独立预测因素。一个简单的模型可用于计算肝移植后发生精神状态改变的风险。
