Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, PO BOX 30 001, 9700 RB, Groningen, The Netherlands,
J Clin Monit Comput. 2013 Oct;27(5):591-8. doi: 10.1007/s10877-013-9474-1. Epub 2013 May 16.
Early postoperative complications after orthotopic liver transplantation (OLT) are a common problem in intensive care medicine. Adequate assessment of initial graft function remains difficult, however, plasma disaperance rate of indocyanine green (PDRICG) may have an additional diagnostic and prognostic value in this setting. We retrospectively evaluated the ability of intraoperative PDRICG values to predict absence of early postoperative complications in 62 subjects. PDRICG was measured non-invasively by pulse dye densitometry during surgery and was correlated with initial graft function. At the end of surgery, PDRICG was higher in patients without complications: 24.9 % min(-1) (n = 40) versus 21.0 % min(-1), (n = 22; p = 0.034). An area under the ROC curve (AUROC) for PDRICG was 0.70, while the AUROC for pH, lactate and PT at ICU admission were 0.53, 0.50 and 0.46, respectively. The AUROC of serum bilirubin and PT at postoperative day 5 were 0.68 and 0.49, respectively. The optimal cut-off PDRICG value for predicting absence of development early postoperative complications was determined to be 23.5 % min(-1) with 72.4 % sensitivity and 71.0 % specificity. Intraoperative point-of-care PDRICG measurement during OLT already predicts absence of early postoperative complications, better and earlier than clinically used laboratory parameters.
原位肝移植（OLT）后早期术后并发症是重症监护医学中的一个常见问题。然而，对于初始移植物功能的充分评估仍然很困难，而吲哚菁绿（ICG）血浆消失率（PDRICG）在这种情况下可能具有额外的诊断和预后价值。我们回顾性评估了术中 PDRICG 值预测 62 例患者早期术后并发症缺失的能力。术中通过脉冲染料密度测定法非侵入性地测量 PDRICG，并与初始移植物功能相关。在手术结束时，无并发症患者的 PDRICG 较高：24.9%min(-1)（n=40）与 21.0%min(-1)，（n=22；p=0.034）。PDRICG 的 ROC 曲线下面积（AUROC）为 0.70，而 ICU 入院时 pH、乳酸和 PT 的 AUROC 分别为 0.53、0.50 和 0.46。术后第 5 天血清胆红素和 PT 的 AUROC 分别为 0.68 和 0.49。预测无早期术后并发症发展的最佳 PDRICG 截断值为 23.5%min(-1)，灵敏度为 72.4%，特异性为 71.0%。OLT 期间术中即时 PDRICG 测量已经可以预测早期术后并发症的缺失，优于且早于临床使用的实验室参数。
