Lu Ru-Yi, Zhu Heng-Kai, Liu Xiang-Yan, Zhuang Li, Wang Zhuo-Yi, Lei Yuan-Li, Wang Ting, Zheng Shu-Sen
Department of Neurology, Shulan (Hangzhou) Hospital, Shulan International Medical College, Zhejiang Shuren University, Hangzhou 310022, China.
Department of Hepatobiliary and Pancreatic Surgery, Shulan (Hangzhou) Hospital, Shulan International Medical College, Zhejiang Shuren University, Hangzhou 310022, China.
J Pers Med. 2022 Jan 21;12(2):141. doi: 10.3390/jpm12020141.
This study aimed to explore the correlation between preoperative total bilirubin (TBil) level and postoperative delirium (POD) in orthotopic liver transplantation (OLT). All the OLT consecutively performed between April 2019 and March 2021 were retrospectively reviewed with data retrieved from a prospectively collected database. Logistic regression model and generalized additive model were used to identify both linear and non-linear relationships between TBil and POD. A two-piecewise regression model was performed to calculate the saturation effect. Subgroup analyses were performed using stratified logistic regression models. A total of 402 recipients were enrolled. After fully adjusted for covariates, TBil was indicated to have a non-linear relationship with POD. The two-piecewise regression model showed the inflection point was 20 mg/dL. On the left side of the inflection point, the incidence of POD increased by 5% per 1 mg/dL increment of TBil ( = 0.026). On the right side of the inflection point, the effect size had no statistical significance (OR, 0.97; 95% CI, 0.90-1.05; = 0.482). The relationship between preoperative TBil level and POD incidence is non-linear in OLT recipients. The incidence of POD is positively correlated with TBil level when it is below 20 mg/dL. A saturation effect is observed when TBil level reaches 20 mg/dL.
本研究旨在探讨原位肝移植（OLT）中术前总胆红素（TBil）水平与术后谵妄（POD）之间的相关性。回顾性分析了2019年4月至2021年3月期间连续进行的所有OLT病例，数据来自前瞻性收集的数据库。采用逻辑回归模型和广义相加模型来确定TBil与POD之间的线性和非线性关系。进行了两段式回归模型以计算饱和效应。使用分层逻辑回归模型进行亚组分析。共纳入402例受者。在对协变量进行充分调整后，结果表明TBil与POD之间存在非线性关系。两段式回归模型显示转折点为20mg/dL。在转折点左侧，TBil每增加1mg/dL，POD发生率增加5%（P = 0.026）。在转折点右侧，效应量无统计学意义（OR，0.97；95%CI，0.90 - 1.05；P = 0.482）。在OLT受者中，术前TBil水平与POD发生率之间的关系是非线性的。当TBil水平低于20mg/dL时，POD发生率与TBil水平呈正相关。当TBil水平达到20mg/dL时，观察到饱和效应。
