VanWagner Lisa B, Ning Hongyan, Whitsett Maureen, Levitsky Josh, Uttal Sarah, Wilkins John T, Abecassis Michael M, Ladner Daniela P, Skaro Anton I, Lloyd-Jones Donald M
Department of Medicine, Division of Gastroenterology & Hepatology, Northwestern University Feinberg School of Medicine, Chicago, IL.
Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.
Hepatology. 2017 Dec;66(6):1968-1979. doi: 10.1002/hep.29329. Epub 2017 Nov 6.
Cardiovascular disease (CVD) complications are important causes of morbidity and mortality after orthotopic liver transplantation (OLT). There is currently no preoperative risk-assessment tool that allows physicians to estimate the risk for CVD events following OLT. We sought to develop a point-based prediction model (risk score) for CVD complications after OLT, the Cardiovascular Risk in Orthotopic Liver Transplantation risk score, among a cohort of 1,024 consecutive patients aged 18-75 years who underwent first OLT in a tertiary-care teaching hospital (2002-2011). The main outcome measures were major 1-year CVD complications, defined as death from a CVD cause or hospitalization for a major CVD event (myocardial infarction, revascularization, heart failure, atrial fibrillation, cardiac arrest, pulmonary embolism, and/or stroke). The bootstrap method yielded bias-corrected 95% confidence intervals for the regression coefficients of the final model. Among 1,024 first OLT recipients, major CVD complications occurred in 329 (32.1%). Variables selected for inclusion in the model (using model optimization strategies) included preoperative recipient age, sex, race, employment status, education status, history of hepatocellular carcinoma, diabetes, heart failure, atrial fibrillation, pulmonary or systemic hypertension, and respiratory failure. The discriminative performance of the point-based score (C statistic = 0.78, bias-corrected C statistic = 0.77) was superior to other published risk models for postoperative CVD morbidity and mortality, and it had appropriate calibration (Hosmer-Lemeshow P = 0.33).
The point-based risk score can identify patients at risk for CVD complications after OLT surgery (available at www.carolt.us); this score may be useful for identification of candidates for further risk stratification or other management strategies to improve CVD outcomes after OLT. (Hepatology 2017;66:1968-1979).
心血管疾病（CVD）并发症是原位肝移植（OLT）后发病和死亡的重要原因。目前尚无术前风险评估工具能让医生估计OLT后发生CVD事件的风险。我们试图在一家三级护理教学医院（2002 - 2011年）对1024例年龄在18 - 75岁、接受首次OLT的连续患者队列中，开发一种基于点数的OLT后CVD并发症预测模型（风险评分），即原位肝移植心血管风险评分。主要结局指标为1年内主要CVD并发症，定义为因CVD原因死亡或因重大CVD事件（心肌梗死、血管重建、心力衰竭、心房颤动、心脏骤停、肺栓塞和/或中风）住院。自举法得出最终模型回归系数的偏差校正95%置信区间。在1024例首次OLT受者中，329例（32.1%）发生了主要CVD并发症。纳入模型（使用模型优化策略）的变量包括术前受者年龄、性别、种族、就业状况、教育状况、肝细胞癌病史、糖尿病、心力衰竭、心房颤动、肺或系统性高血压以及呼吸衰竭。基于点数的评分的判别性能（C统计量 = 0.78，偏差校正C统计量 = 0.77）优于其他已发表的术后CVD发病和死亡风险模型，且具有适当的校准（Hosmer - Lemeshow P = 0.33）。
基于点数的风险评分可识别OLT手术后有CVD并发症风险的患者（可在www.carolt.us获取）；该评分可能有助于识别进一步风险分层或其他管理策略的候选者，以改善OLT后的CVD结局。（《肝脏病学》2017年；66:1968 - 1979）
