[巴西南部肝移植术后APACHE IV评分的验证：一项队列研究]

[Validation of APACHE IV score in postoperative liver transplantation in southern Brazil: a cohort study].

作者信息

Rodrigues Filho Edison Moraes, Garcez Anderson, Nedel Wagner Luis

机构信息

Irmandade Santa Casa de Misericórdia de Porto Alegre, Hospital Dom Vicente Scherer, Unidade de Terapia Intensiva de Transplantes, Porto Alegre, RS, Brasil.

Universidade do Vale do Rio dos Sinos (UNISINOS), São Leopoldo, RS, Brasil.

出版信息

Braz J Anesthesiol. 2019 May-Jun;69(3):279-283. doi: 10.1016/j.bjan.2018.11.010. Epub 2019 May 7.

DOI:10.1016/j.bjan.2018.11.010

PMID:31072607

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9391888/

Abstract

BACKGROUND

Liver transplantation is the only curative therapeutic modality available for individuals at end-stage liver disease. There is no reliable method of predicting the early postoperative outcome of these patients. The Acute Physiology and Chronic Health Evaluation (APACHE) is a widely used model for predicting hospital survival and benchmarking in critically ill patients. This study evaluated the calibration and discrimination of APACHE IV in the postoperative period of elective liver transplantation in the southern Brazil.

METHODS

This was a clinical prospective and unicentric cohort study that included 371 adult patients in the immediate postoperative period of elective liver transplantation from January 1, 2012 to December 31, 2016.

RESULTS

In this study, liver transplant patients who evolved to hospital death had a significantly higher APACHE IV score (82.7 ± 5.1 vs. 51.0 ± 15.8; < 0.001) and higher predicted mortality (6.5% [4.4–20.2%] vs. 2.3% [1.4–3.5%]; < 0.001). The APACHE IV score showed an adequate calibration (Hosmer-Lemeshow – H-L = 11.37; = 0.181) and good discrimination (Receiver Operator Curve – ROC of 0.797; Confidence Interval 95% – 95% CI 0.713–0.881; < 0.0001), although Standardized Mortality Ratio (SMR = 2.63), (95% CI 1.66–4.27; < 0.001) underestimate mortality.

CONCLUSIONS

In summary, the APACHE IV score showed an acceptable performance for predicting a hospital outcome in the postoperative period of elective liver transplant recipients.

摘要

背景

肝移植是终末期肝病患者唯一可用的治愈性治疗方式。目前尚无可靠方法预测这些患者的术后早期结局。急性生理学与慢性健康状况评估（APACHE）是一种广泛用于预测危重症患者医院生存率和进行基准比较的模型。本研究评估了APACHE IV在巴西南部择期肝移植术后阶段的校准和区分能力。

方法

这是一项临床前瞻性单中心队列研究，纳入了2012年1月1日至2016年12月31日期间371例择期肝移植术后即刻的成年患者。

结果

在本研究中，发展为医院死亡的肝移植患者的APACHE IV评分显著更高（82.7±5.1 vs. 51.0±15.8；P<0.001），预测死亡率也更高（6.5%[4.4–20.2%] vs. 2.3%[1.4–3.5%]；P<0.001）。APACHE IV评分显示校准良好（Hosmer-Lemeshow检验 - H-L = 11.37；P = 0.181）且区分能力良好（受试者操作特征曲线 - ROC为0.797；9置信区间5% - 置信区间95%为0.713–0.881；P<0.0001），尽管标准化死亡比（SMR = 2.63）（95%置信区间1.66–4.27；P<0.001）低估了死亡率。