Rudasill Sarah E, DiPardo Benjamin, Sanaiha Yas, Mardock Alexandra L, Cale Mario, Antonios James W, Khoury Habib, Benharash Peyman
Am Surg. 2019 Oct 1;85(10):1184-1188.
Guidelines suggest targeting a preoperative international normalized ratio (INR) < 1.5. We examined and compared the predictive value of INR relative to the Model for End-Stage Liver Disease (MELD). We reviewed the American College of Surgeons NSQIP from 2005 to 2016 for adult patients undergoing open or laparoscopic cholecystectomy. Patients with a preoperative INR were stratified into groups: ≤1, >1 to ≤1.5, >1.5 to ≤2, and >2. Thirty day postoperative mortality was the primary outcome. Multivariable logistic regressions controlled for baseline differences. Of 58,177 cholecystectomy patients, 15.2 per cent had INR ≤ 1, 80.4 per cent had INR > 1 to ≤1.5, 3.7 per cent had INR > 1.5 to ≤2, and 0.7 per cent had INR > 2. Patients with INR > 2 were older and more likely to have diabetes and hypertension ( < 0.001). Multivariable regression demonstrated a stepwise increase in mortality for INR > 1 to ≤1.5 (odds ratio (OR) = 1.50 [1.10-2.05]), INR > 1.5 to ≤2 (OR = 2.96 [1.97-4.45]), and INR > 2 (OR = 3.21 [1.64-6.31]) relative to INR ≤ 1. C-statistic for INR (0.910) and MELD (0.906) models indicated a similar value in predicting mortality. INR groups also faced an incremental, increased risk of bleeding. Although unable to track preoperative correction of INR, this analysis identifies that INR remains an excellent predictor of postoperative mortality and bleeding after both open and laparoscopic cholecystectomies and is comparable to MELD.
指南建议将术前国际标准化比值（INR）的目标设定为<1.5。我们研究并比较了INR相对于终末期肝病模型（MELD）的预测价值。我们回顾了2005年至2016年美国外科医师学会国家外科质量改进计划（NSQIP）中接受开放或腹腔镜胆囊切除术的成年患者。术前INR的患者被分为几组：≤1、>1至≤1.5、>1.5至≤2以及>2。术后30天死亡率是主要结局。多变量逻辑回归控制了基线差异。在58177例胆囊切除术患者中，15.2%的患者INR≤1，80.4%的患者INR>1至≤1.5，3.7%的患者INR>1.5至≤2，0.7%的患者INR>2。INR>2的患者年龄更大，更有可能患有糖尿病和高血压（P<0.001）。多变量回归显示，相对于INR≤1，INR>1至≤1.5（比值比（OR）=1.50[1.10 - 2.05]）、INR>1.5至≤2（OR = 2.96[1.97 - 4.45]）以及INR>2（OR = 3.21[1.64 - 6.31]）时死亡率呈逐步上升。INR模型（0.910）和MELD模型（0.906）的C统计量表明在预测死亡率方面具有相似的值。INR分组也面临着出血风险的逐步增加。尽管无法追踪术前INR的纠正情况，但该分析表明，INR仍然是开放和腹腔镜胆囊切除术后术后死亡率和出血的优秀预测指标，并且与MELD相当。
