Department of Student Affairs, Baylor College of Medicine, Houston, TX, USA.
Division of Abdominal Transplantation, Michael E DeBakey Department of General Surgery, Baylor College of Medicine, Houston, TX, USA.
Pediatr Transplant. 2020 Nov;24(7):e13779. doi: 10.1111/petr.13779. Epub 2020 Jul 28.
PELD scores are used to reduce waitlist mortality, but they do not accurately predict likelihood of prolonged length-of-stay or higher costs associated with it. This study aims to create a pediatric length-of-stay (LOS) index to predict increased risk of prolonged stay following liver transplantation.
The scoring system generated predicts length-of-stay following pediatric liver transplantation. With univariate and multivariate analyses on data from 5669 pediatric liver transplant recipients, independent recipient/donor risk factors for prolonged stay (>30 days) were identified. Multiple imputations accounted for missing variables.
The most significant factors were ICU admission (OR 2.92, CI 2.27-3.75), recipient bilirubin >32 (OR 2.35, CI 1.70-3.25), and hemodialysis 1 week before transplantation (OR 2.27, CI 1.57-3.27). The LOS index assigns weighted scoring points to factors to predict prolonged stay (C-statistic of .72). The index demonstrated discrimination across the population after dividing it into quartiles for prolonged stay.
The pediatric LOS index, utilizing 13 donor/recipient factors, can assess the risk for pediatric liver transplantation prolonged stay. Important predictive factors are hemodialysis, ICU admission, recipient weight and bilirubin, and recipient life support status.
PELD 评分用于降低等待名单上的死亡率，但它们并不能准确预测延长住院时间或与之相关的更高费用的可能性。本研究旨在创建一个儿科住院时间 (LOS) 指数，以预测肝移植后延长住院时间的风险增加。
该评分系统用于预测儿科肝移植后的住院时间。通过对 5669 名儿科肝移植受者的数据进行单因素和多因素分析，确定了延长住院时间 (>30 天) 的独立受者/供者危险因素。采用多重插补法处理缺失变量。
最显著的因素是 ICU 入院（OR 2.92，95%CI 2.27-3.75）、受者胆红素>32（OR 2.35，95%CI 1.70-3.25）和移植前 1 周血液透析（OR 2.27，95%CI 1.57-3.27）。LOS 指数根据因素分配加权评分点以预测延长住院时间（C 统计量为 0.72）。该指数在将人群分为延长住院时间的四分位数后，在整个人群中表现出了区分能力。
利用 13 个供者/受者因素的儿科 LOS 指数，可以评估儿科肝移植延长住院时间的风险。重要的预测因素是血液透析、ICU 入院、受者体重和胆红素以及受者生命支持状态。
