Department of Anesthesiology, University Hospital of Bellvitge (IDIBELL), University of Barcelona Health Campus, Barcelona, Spain -
Department of Anesthesiology, University Clinical Hospital, IDIBAPS, University of Barcelona Health Campus, Barcelona, Spain.
Minerva Anestesiol. 2018 Apr;84(4):447-454. doi: 10.23736/S0375-9393.17.12023-7. Epub 2017 Nov 6.
In liver transplantation most studies were designed to predict massive transfusion rather than whether or not transfusion is required. We hypothesized that (presurgery) data from thromboelastometry may predict perioperative blood requirements.
A post-hoc analysis of data from a controlled trial was performed with the primary end point of predicting zero red blood cells. Of the 92 patients studied, 6 were excluded because of incomplete EXTEM and/or FIBTEM data. The multivariate models included preoperative variables with a P value <0.10 in the univariate model: age, MELD score, hemoglobin, plasma fibrinogen, platelet count, activated partial thromboplastin time, INR, EXTEM maximum clot amplitude after 10 minutes, EXTEM an FIBTEM maximum clot firmness, plasma creatinine, and donor data.
Blood was transfused to 58% of patients during the surgical procedure and to 34% in the first 24 hours postoperatively. The final model was selected using a backward approach, and fractional polynomials were explored to assess model improvement for the prediction. Hemoglobin was a strong predictor: each 1 g/dL of hemoglobin increase reduced the risk of blood transfusion by 52%. An EXTEM maximum amplitude at 10 min was also a predictor of Red Blood requirement, showing a 64% risk reduction for values between the first quartile (35 mm) and the second quartile (41 mm) but no further improvement for the third and fourth quartiles and resulting in a prediction (ROC AUC of 0.815 [0.771-0.859]).
Presurgical EXTEM maximum amplitude at 10 min <35 mm is highly predictive of red blood administration during liver transplantation.
在肝移植中，大多数研究旨在预测大量输血，而不是是否需要输血。我们假设血栓弹性描记术（thromboelastometry）的术前数据可能可以预测围手术期的血液需求。
对一项对照试验的数据进行了事后分析，主要终点是预测零红细胞输注。在研究的 92 名患者中，有 6 名因 EXTEM 和/或 FIBTEM 数据不完整而被排除。多变量模型包括在单变量模型中 P 值<0.10 的术前变量：年龄、MELD 评分、血红蛋白、血浆纤维蛋白原、血小板计数、活化部分凝血活酶时间、INR、EXTEM 10 分钟后最大凝血幅度、EXTEM 和 FIBTEM 最大凝血硬度、血浆肌酐和供体数据。
58%的患者在手术过程中输血，34%的患者在术后 24 小时内输血。最终模型是使用后向法选择的，探索了分数多项式以评估预测的模型改进。血红蛋白是一个强有力的预测因素：血红蛋白每增加 1 g/dL，输血的风险就降低 52%。EXTEM 10 分钟时的最大幅度也是红细胞需求的预测指标，第一四分位数（35mm）和第二四分位数（41mm）之间的数值风险降低了 64%，但对于第三和第四四分位数没有进一步的改善，导致预测（ROC AUC 为 0.815 [0.771-0.859]）。
肝移植前 EXTEM 10 分钟最大幅度<35mm 高度预测了红细胞的输注。
