Park Jaesik, Kim Bae Wook, Choi Ho Joong, Hong Sang Hyun, Park Chul Soo, Choi Jong Ho, Chae Min Suk
Department of Anesthesiology and Pain medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.
Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
BMC Surg. 2020 Mar 12;20(1):2. doi: 10.1186/s12893-019-0658-6.
This study investigated perioperative clinical risk factors for early post-transplant bacteremia in patients undergoing living donor liver transplantation (LDLT). Additionally, postoperative outcomes were compared between patients with and without early post-transplant bacteremia.
Clinical data of 610 adult patients who underwent elective LDLT between January 2009 and December 2018 at Seoul St. Mary's Hospital were retrospectively collected. The exclusion criteria included overt signs of infection within 1 month before surgery. A total of 596 adult patients were enrolled in this study. Based on the occurrence of a systemic bacterial infection after surgery, patients were classified into non-infected and infected groups.
The incidence of bacteremia at 1 month after LDLT was 9.7% (57 patients) and Enterococcus faecium (31.6%) was the most commonly cultured bacterium in the blood samples. Univariate analysis showed that preoperative psoas muscle index (PMI), model for end-stage disease score, utility of continuous renal replacement therapy (CRRT), ascites, C-reactive protein to albumin ratio, neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio, and sodium level, as well as intraoperative post-reperfusion syndrome, mean central venous pressure, requirement for packed red blood cells and fresh frozen plasma, hourly fluid infusion and urine output, and short-term postoperative early allograft dysfunction (EAD) were associated with the risk of early post-transplant bacteremia. Multivariate analysis revealed that PMI, the CRRT requirement, the NLR, and EAD were independently associated with the risk of early post-transplant bacteremia (area under the curve: 0.707; 95% confidence interval: 0.667-0.745; p < 0.001). The overall survival rate was better in the non-infected patient group. Among patients with bacteremia, anti-bacterial treatment was unable to resolve infection in 34 patients, resulting in an increased risk of patient mortality. Among the factors included in the model, EAD was significantly correlated with non-resolving infection.
We propose a prognostic model to identify patients at high risk for a bloodstream bacterial infection; furthermore, our findings support the notion that skeletal muscle depletion, CRRT requirement, systemic inflammatory response, and delayed liver graft function are associated with a pathogenic vulnerability in cirrhotic patients who undergo LDLT.
本研究调查了活体肝移植（LDLT）患者移植后早期菌血症的围手术期临床危险因素。此外，对有和没有移植后早期菌血症的患者的术后结局进行了比较。
回顾性收集了2009年1月至2018年12月在首尔圣母医院接受择期LDLT的610例成年患者的临床资料。排除标准包括术前1个月内有明显感染迹象。本研究共纳入596例成年患者。根据术后全身细菌感染的发生情况，将患者分为未感染组和感染组。
LDLT术后1个月菌血症的发生率为9.7%（57例患者），粪肠球菌（31.6%）是血样中最常培养出的细菌。单因素分析显示，术前腰大肌指数（PMI）、终末期疾病评分模型、连续性肾脏替代治疗（CRRT）的使用、腹水、C反应蛋白与白蛋白比值、中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值、钠水平，以及术中再灌注综合征、平均中心静脉压、浓缩红细胞和新鲜冰冻血浆的需求量、每小时液体输注量和尿量，以及术后短期早期移植物功能障碍（EAD）与移植后早期菌血症的风险相关。多因素分析显示，PMI、CRRT需求、NLR和EAD与移植后早期菌血症的风险独立相关（曲线下面积：0.707；95%置信区间：0.667-0.745；p<0.001）。未感染患者组的总生存率更高。在菌血症患者中，34例患者的抗菌治疗未能解决感染问题，导致患者死亡风险增加。在模型中的因素中，EAD与未解决的感染显著相关。
我们提出了一个预后模型，以识别血流细菌感染的高危患者；此外，我们的研究结果支持以下观点，即骨骼肌消耗、CRRT需求、全身炎症反应和肝移植功能延迟与接受LDLT的肝硬化患者的致病易感性有关。
