Niewińsk G, Raszeja-Wyszomirska J, Główczyńska R, Figiel W, Zając K, Kornasiewicz O, Zieniewicz K, Grąt M
II Department of Anaesthesiology and Intensive Care, Medical University of Warsaw, Warsaw, Poland.
Liver and Internal Medicine Unit, Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland.
Transplant Proc. 2018 Sep;50(7):2014-2017. doi: 10.1016/j.transproceed.2018.02.143. Epub 2018 Mar 14.
Prolonged initial intensive care unit (ICU) stay after liver transplantation (LT) is associated with prolonged total hospitalization, increased hospital mortality, and impaired patient and graft survival. Recent data suggested that model for end-stage liver disease (MELD) score at the time of LT and the length of surgery were the two independent risk factors for an ICU stay longer than 3 days after LT. We further identified factors influencing prolonged ICU stay in single-center liver graft recipients.
One hundred fifty consecutive LT recipients (M/F 94/56, median age 55 (range, 39-60), 36% with viral hepatitis, were prospectively enrolled into the study. Associations between clinical factors and prolonged ICU stay were evaluated using logistic regression models. Receiver operating characteristic curves were analyzed to determine the appropriate cutoffs for continuous variables. Threshold for significance was P ≤ .05.
Highly prolonged (≥8 days) and moderately prolonged (≥6 days) postoperative ICU stay was noted in 19 (12.7%) and 59 (39.3%) patients, respectively. Serum bilirubin (P = .001) and creatinine concentrations (P = .011), international normalized ratio (P = .004), and sodium-MELD (P < .001) were all significantly associated with postoperative intensive care unit stay over or equal to 75th percentile (6 days). Sodium-MELD was significantly associated with postoperative care unit stay greater or equal to the 90th percentile (8 days; P = .018).
Sodium-MELD might be a novel risk factor of prolonged ICU stay in this single-center experience.
肝移植（LT）后初始重症监护病房（ICU）住院时间延长与总住院时间延长、医院死亡率增加以及患者和移植物存活率受损相关。近期数据表明，LT时的终末期肝病模型（MELD）评分和手术时长是LT后ICU住院时间超过3天的两个独立危险因素。我们进一步确定了影响单中心肝移植受者ICU住院时间延长的因素。
连续纳入150例LT受者（男/女94/56，中位年龄55岁（范围39 - 60岁），36%为病毒性肝炎患者）进行前瞻性研究。使用逻辑回归模型评估临床因素与ICU住院时间延长之间的关联。分析受试者工作特征曲线以确定连续变量的合适截断值。显著性阈值为P≤0.05。
分别有19例（12.7%）和59例（39.3%）患者术后ICU住院时间高度延长（≥8天）和中度延长（≥6天）。血清胆红素（P = 0.001）、肌酐浓度（P = 0.011）、国际标准化比值（P = 0.004）和钠-MELD（P < 0.001）均与术后重症监护病房住院时间超过或等于第75百分位数（6天）显著相关。钠-MELD与术后监护病房住院时间大于或等于第90百分位数（8天；P = 0.018）显著相关。
在本单中心经验中，钠-MELD可能是ICU住院时间延长的一个新危险因素。
