Luo Qipeng, Jia Yuan, Su Zhanhao, Wang Hongbai, Li Yinan, Wu Xie, Liu Qiao, Liu Xiaoguang, Yuan Su, Yan Fuxia
Pain Medicine Center, Peking University Third Hospital, Peking University Health Science Center, Beijing, China.
Department of Anesthesiology, Fuwai Hospital, National Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Front Cardiovasc Med. 2022 Apr 26;9:820791. doi: 10.3389/fcvm.2022.820791. eCollection 2022.
Studies have reported early liver dysfunction (LD) after cardiac surgery is associated with short and long-term mortality. In this study, we aimed to investigate risk factors for persistent LD after total cavopulmonary connection (TCPC) surgery.
This is a retrospective case-control study. We defined persistent LD as LDs occurring between postoperative day 1 (POD1) and POD7 and sustaining at least on POD7, while transient LD as LDs occurring between POD1 and POD7 and recovering at least on POD7. Multivariable logistic regression analysis was applied and central venous pressure (CVP) was considered continuously or in quantiles.
Postoperative LD occurred in 111 (27.1%) patients. Transient and persistent LD occurred in 65 (15.9%) and 46 (11.2%) patients, respectively. Aortic cross-clamping (ACC) (odds ratio [OR] 2.55, 95% CI 1.26-5.14) and postoperative CVP (OR 1.34, 95% CI 1.18-1.51) were risk factors for persistent LD, also identified for postoperative any LD and transient LD. Adding postoperative CVP to the model only including ACC significantly improved persistent LD prediction (△AUC 0.15, = 0.002). Compared with CVP ≤ 14 mmHg, adjusted ORs and 95% CI of persistent LD for CVP of 14-16 and >16 mmHg were 3.11 (1.24, 7.81) and 10.55 (3.72, 29.93), respectively. Patients with persistent LD might have a longer length of mechanical ventilation (mean difference, 13.5 h) and postoperative hospital stay (mean difference, 7 days), and higher postoperative costs (mean difference, 6.7 thousand dollars) compared to those with transient LD.
Intra-operative application of ACC and postoperative elevated CVP were independent risk factors for persistent LD in pediatric patients following TCPC surgery. Compared to patients with transient LD, patients with persistent LD might have a longer length of mechanical ventilation and postoperative hospital stay, and higher postoperative costs. We should pay more attention to patients with high postoperative CVP to prevent their persistent LD occurrence.
研究报告称，心脏手术后早期肝功能障碍（LD）与短期和长期死亡率相关。在本研究中，我们旨在调查全腔静脉肺动脉连接（TCPC）手术后持续性LD的危险因素。
这是一项回顾性病例对照研究。我们将持续性LD定义为术后第1天（POD1）至第7天出现且至少持续至POD7的LD，而短暂性LD定义为POD1至POD7出现且至少在POD7恢复的LD。应用多变量逻辑回归分析，并将中心静脉压（CVP）视为连续变量或分位数变量。
111例（27.1%）患者术后发生LD。短暂性和持续性LD分别发生在65例（15.9%）和46例（11.2%）患者中。主动脉阻断（ACC）（比值比[OR]2.55，95%可信区间1.26 - 5.14）和术后CVP（OR 1.34，95%可信区间1.18 - 1.51）是持续性LD的危险因素，术后任何LD和短暂性LD也存在这些危险因素。在仅包含ACC的模型中加入术后CVP显著改善了持续性LD的预测（△AUC 0.15， = 0.002）。与CVP≤14 mmHg相比，CVP为14 - 16 mmHg和>16 mmHg时持续性LD的调整后OR及95%可信区间分别为3.11（1.24，7.81）和10.55（3.72，29.93）。与短暂性LD患者相比，持续性LD患者可能机械通气时间更长（平均差异13.5小时）、术后住院时间更长（平均差异7天）且术后费用更高（平均差异6700美元）。
术中应用ACC和术后CVP升高是TCPC手术后小儿患者持续性LD的独立危险因素。与短暂性LD患者相比，持续性LD患者可能机械通气时间更长、术后住院时间更长且术后费用更高。我们应更加关注术后CVP高的患者，以预防其发生持续性LD。
