Department of General, Visceral, and Transplant Surgery, Hannover, Germany.
Liver Transpl. 2013 Aug;19(8):862-71. doi: 10.1002/lt.23673. Epub 2013 Jul 25.
Survival of critically ill patients is significantly affected by prolonged ventilation. The goal of this study was the development of a respiratory risk score (RRS) for the prediction of 3-month mortality and prolonged ventilation after liver transplantation (LT). Two hundred fifty-four consecutive LT patients from a single center were retrospectively randomized into a training group for model design and a validation group. A receiver operating characteristic (ROC) curve analysis was used to test sensitivity and specificity. The accuracy of the predictions was assessed with the Brier score, and the model calibration was assessed with the Hosmer-Lemeshow test. Cutoff values were determined with the best Youden index. The RRS was calculated in the first 24 hours as follows: (laboratory Model for End-Stage Liver Disease score > 30 = 2.36 points) + (fresh frozen plasma > 13.5 U = 2.70 points) + (partial pressure of arterial oxygen/fraction of inspired oxygen ratio < 200 mm Hg = 2.23 points) + (packed red blood cells > 10.5 U = 3.50 points) + (preoperative mechanical ventilation = 3.87 points) + (preoperative dialysis = 2.83 points) + (donor steatosis hepatis > 40% = 2.95 points). The RSS demonstrated high predictive accuracy, good model calibration, and c statistics > 0.7 in the training and validation groups. The RSS was able to predict 3-month mortality [cutoff = 6.64, area under the (ROC) curve (AUROC) = 0.794] and prolonged ventilation (cutoff = 3.69, AUROC = 0.798) with sensitivities of 69% and 81%, specificities of 83% and 73%, and overall model correctness of 76% and 77%, respectively. In conclusion, this study provides the first prognostic model for the prediction of 3-month mortality and prolonged ventilation after LT with high sensitivity and specificity and good model accuracy. The application of the RRS to an external cohort would be desirable for its further validation and introduction as a clinical tool for intensive care resource planning and prognostic decision making.
危重症患者的存活率受到长时间通气的显著影响。本研究的目的是开发一种呼吸风险评分（RRS），用于预测肝移植（LT）后 3 个月的死亡率和长时间通气。从一个单中心回顾性随机抽取 254 例连续 LT 患者进入训练组进行模型设计和验证组。使用接收者操作特征（ROC）曲线分析来测试灵敏度和特异性。用 Brier 评分评估预测的准确性，用 Hosmer-Lemeshow 检验评估模型校准。用最佳 Youden 指数确定截断值。RRS 在最初的 24 小时内计算如下：（终末期肝病模型评分>30=2.36 分）+（新鲜冷冻血浆>13.5U=2.70 分）+（动脉血氧分压/吸入氧分数比<200mmHg=2.23 分）+（浓缩红细胞>10.5U=3.50 分）+（术前机械通气=3.87 分）+（术前透析=2.83 分）+（供体脂肪肝>40%=2.95 分）。RRS 在训练组和验证组中均具有较高的预测准确性、良好的模型校准和 c 统计量>0.7。RRS 能够预测 3 个月死亡率[截断值=6.64，ROC 曲线下面积（AUROC）=0.794]和长时间通气（截断值=3.69，AUROC=0.798），灵敏度分别为 69%和 81%，特异性分别为 83%和 73%，总体模型正确性分别为 76%和 77%。总之，本研究提供了第一个预测 LT 后 3 个月死亡率和长时间通气的预后模型，具有较高的灵敏度和特异性，以及良好的模型准确性。将 RRS 应用于外部队列将有助于进一步验证，并将其作为一种临床工具引入，用于重症监护资源规划和预后决策。
