Division of Hepatobiliary Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA.
Division of Hepatopancreaticobiliary Surgery, Department of Surgery, Carolinas Medical Center, 1025 Morehead Medical Drive, Suite 600, Charlotte, NC, 28204, USA.
Surg Endosc. 2021 Jul;35(7):3811-3817. doi: 10.1007/s00464-020-07760-9. Epub 2020 Jul 6.
Thrombocytopenia is a common finding in patients with chronic liver disease. It is associated with poor clinical outcomes due to increased risk of bleeding after even minor procedures. We sought to determine an algorithm for pre-operative platelet transfusion in patients with cirrhosis and hepatocellular carcinoma (HCC) undergoing laparoscopic microwave ablation (MIS-MWA).
A retrospective review identified all patients with cirrhosis and HCC who underwent MIS-MWA at a single tertiary institution between 2007 and 2019. Demographics, pre-operative and post-operative laboratory values, transfusion requirements, and bleeding events were collected. The analyzed outcome of bleeding risk included any transfusion received intra-operatively or a transfusion or surgical intervention post-operatively. Logistic regression models were created to predict bleeding risk and identify patients who would benefit from pre-operative transfusion.
There were 433 patients with cirrhosis and HCC who underwent MIS-MWA identified; of these, 353 patients had complete laboratory values and were included. Bleeding risk was evaluated through bivariate analysis of statistically and clinically significant variables. The accuracy of both models was substantiated through bootstrap validation for 500 iterations (model 1: ROC 0.8684, Brier score 0.0238; model 2: ROC 0.8363, Brier score 0.0252). The first model captured patients with both thrombocytopenia and anemia: platelet count < 60 × 10 / L (OR 7.75, p 0.012, CI 1.58-38.06) and hemoglobin < 10 gm/dL (OR 5.76, p 0.032, CI 1.16-28.63). The second model captured patients with thrombocytopenia without anemia: platelet count < 30 × 10/L (OR 8.41, p 0.05, CI 0.96-73.50) and hemoglobin > 10 gm/dL (OR 0.16, p 0.026, CI 0.031-0.80).
The prediction of patients with cirrhosis and HCC requiring pre-operative platelet transfusions may help to avoid bleeding complications after invasive procedures. This study needs to be prospectively validated and ultimately may be beneficial in assessment of novel therapies for platelet-based clinical treatment in liver disease.
血小板减少症是慢性肝病患者常见的表现。由于即使是轻微的手术后也会增加出血风险，因此它与不良临床结局相关。我们旨在确定肝硬化和肝细胞癌（HCC）患者行腹腔镜微波消融（MIS-MWA）术前血小板输注的算法。
回顾性分析了 2007 年至 2019 年期间在一家三级医疗机构接受 MIS-MWA 的所有肝硬化和 HCC 患者。收集了人口统计学、术前和术后实验室值、输血需求和出血事件。分析的出血风险包括术中任何输血或术后输血或手术干预。创建了逻辑回归模型来预测出血风险，并确定需要术前输血的患者。
共确定了 433 例肝硬化和 HCC 患者行 MIS-MWA；其中 353 例患者具有完整的实验室值并被纳入分析。通过对统计学和临床有意义的变量进行双变量分析来评估出血风险。通过对 500 次迭代进行引导验证来证实两个模型的准确性（模型 1：ROC 0.8684，Brier 评分 0.0238；模型 2：ROC 0.8363，Brier 评分 0.0252）。第一个模型捕获了同时患有血小板减少症和贫血的患者：血小板计数＜60×10/L（OR 7.75，p=0.012，CI 1.58-38.06）和血红蛋白＜10gm/dL（OR 5.76，p=0.032，CI 1.16-28.63）。第二个模型捕获了无贫血的血小板减少症患者：血小板计数＜30×10/L（OR 8.41，p=0.05，CI 0.96-73.50）和血红蛋白＞10gm/dL（OR 0.16，p=0.026，CI 0.031-0.80）。
预测需要术前血小板输注的肝硬化和 HCC 患者可能有助于避免侵入性手术后的出血并发症。这项研究需要前瞻性验证，最终可能有助于评估针对肝病血小板的新型治疗方法的临床治疗。
