术后血小板计数低与成人原位肝移植受者的主要并发症和生存率降低相关。
Low Postoperative Platelet Counts Are Associated with Major Morbidity and Inferior Survival in Adult Recipients of Orthotopic Liver Transplantation.
机构信息
Department of Surgery and Transplantation, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany.
Department of Internal Medicine III, University Hospital RWTH Aachen, Aachen, Germany.
出版信息
J Gastrointest Surg. 2020 Sep;24(9):1996-2007. doi: 10.1007/s11605-019-04337-3. Epub 2019 Aug 6.
BACKGROUND
Platelets (PLT) play an essential functional role in cellular injury and liver regeneration following partial hepatectomy and orthotopic liver transplantation (OLT). Here, we investigated the association of postoperative PLT counts with short- and long-term outcomes in adult OLT recipients.
METHODS
Three hundred consecutive patients from our prospective OLT database were analyzed retrospectively (May 2010-November 2017). Ninety-day post-OLT complications were graded using the Clavien-Dindo (CD) classification and quantified by the comprehensive complication index (CCI). To determine the prognostic accuracy of PLT counts, the area under the receiver operating characteristic curve (AUROC) was calculated for major complications (CD ≥ 3b). Parametric and non-parametric tests were applied for subgroup analyses. Uni- and multivariable logistic regression analyses were performed to identify risk factors for major complications. Graft and patient survival were analyzed using the Kaplan-Meier method as well as uni- and multivariable Cox regression analyses.
RESULTS
Postoperative day 6 PLT counts < 70 × 10/L (POD6-70) were identified as the best cutoff for predicting major complications (AUROC = 0.7; p < 0.001; Youden index 0.317). The stratification of patients into low- (n = 113) and high-PLT (n = 187) groups highlighted significant differences in major complications (CCI 68 ± 29 vs. 43 ± 28, p < 0.001); length of hospital and intensive care unit (ICU) stay (53 ± 43 vs. 31 ± 25, p < 0.001; 21 ± 29 vs. 7 ± 11, p < 0.001, respectively) and estimated procedural costs. POD6-70 was associated with inferior 5-year graft survival. Multivariable logistic regression analysis identified POD6-70 as an independent predictor of major complications (odds ratio 2.298, confidence intervals 1.179-4.478, p = 0.015).
CONCLUSION
In OLT patients, a PLT count on POD6 of less than 70 × 10/L bears a prognostic significance warranting further investigations.
背景
血小板（PLT）在部分肝切除术和原位肝移植（OLT）后细胞损伤和肝脏再生中发挥着重要的功能作用。在这里，我们研究了 OLT 受者术后 PLT 计数与短期和长期结局的关系。
方法
我们回顾性分析了来自前瞻性 OLT 数据库的 300 例连续患者（2010 年 5 月至 2017 年 11 月）。OLT 后 90 天并发症使用 Clavien-Dindo（CD）分类进行分级，并通过综合并发症指数（CCI）进行量化。为了确定 PLT 计数的预后准确性，计算了主要并发症（CD≥3b）的受试者工作特征曲线（AUROC）下面积。应用参数和非参数检验进行亚组分析。进行单变量和多变量逻辑回归分析以确定主要并发症的危险因素。使用 Kaplan-Meier 方法以及单变量和多变量 Cox 回归分析评估移植物和患者的存活率。
结果
术后第 6 天 PLT 计数＜70×10/L（POD6-70）被确定为预测主要并发症的最佳截断值（AUROC=0.7；p＜0.001；Youden 指数 0.317）。将患者分为低血小板组（n=113）和高血小板组（n=187），两组之间在主要并发症（CCI 68±29 vs. 43±28，p＜0.001）；住院和重症监护病房（ICU）的住院时间（53±43 vs. 31±25，p＜0.001；21±29 vs. 7±11，p＜0.001）和估计的程序费用方面存在显著差异。POD6-70 与 5 年移植物存活率降低相关。多变量逻辑回归分析确定 POD6-70 是主要并发症的独立预测因子（比值比 2.298，95%置信区间 1.179-4.478，p=0.015）。
结论
在 OLT 患者中，POD6 时的 PLT 计数低于 70×10/L 具有预后意义，值得进一步研究。
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