Wang Ryan, Katz Daniel, Lin Hung-Mo, Ouyang Yuxia, Gal Jonathan, Suresh Sumanth, Labgaa Ismail, Tabrizian Parissa, Demaria Samuel, Zerillo Jeron, Smith Natalie K
Department of Anesthesiology, Perioperative and Pain Medicine, 5925Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Department of Population Health Science and Policy, 5925Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Semin Cardiothorac Vasc Anesth. 2023 Mar;27(1):16-24. doi: 10.1177/10892532221141138. Epub 2022 Nov 21.
Serum albumin's association with liver transplant outcomes has been investigated with mixed findings. This study aimed to evaluate perioperative albumin level, independently and as part of the albumin-bilirubin (ALBI) grade, as a predictor of post-liver transplant hospital and intensive care unit (ICU) length of stay (LOS).
Adult liver-only transplant recipients at our institution from September 2011 to May 2019 were included in this retrospective study. Repeat transplants were excluded. Demographic, laboratory, and hospital course data were extracted from an institutional data warehouse. Negative binomial regression was used to assess the association of LOS with ALBI grade, age, BMI, ASA score, Elixhauser comorbidity index, MELD-Na, warm ischemia time, units of platelets and cryoprecipitate transfused, and preoperative serum albumin.
Six hundred and sixty-three liver transplant recipients met inclusion criteria. The median preoperative serum albumin was 3.1 [2.6-3.6] g/dL. The median postoperative ICU and hospital LOS were 3.8 [2.4-6.8] and 12 [8-20] days, respectively. Preoperative serum albumin predicted hospital but not ICU LOS (ratio .9 [95% confidence interval (CI) .84-.99], = .03, hospital LOS vs ratio .92 [95% CI 0.84-1.02], = .10, ICU LOS). For patients with MELD-Na ≤ 20, ALBI grade-3 predicted longer hospital and ICU LOS (ratio 1.40 [95% CI 1.18-1.66], < .001, hospital LOS vs ratio 1.62 [95% CI 1.32-1.99], < .001, ICU LOS). These associations were not significant for patients with MELD-Na > 20.
Serum albumin predicted post-liver transplant hospital LOS. ALBI grade-3 predicted increased hospital and ICU LOS in low MELD-Na recipients.
血清白蛋白与肝移植结局之间的关联已有研究，但结果不一。本研究旨在评估围手术期白蛋白水平，独立评估以及作为白蛋白-胆红素（ALBI）分级的一部分，作为肝移植术后住院时间和重症监护病房（ICU）住院时长（LOS）的预测指标。
本回顾性研究纳入了2011年9月至2019年5月在我院仅接受肝移植的成年受者。再次移植的患者被排除。从机构数据仓库中提取人口统计学、实验室和住院过程数据。采用负二项回归评估LOS与ALBI分级、年龄、体重指数、美国麻醉医师协会（ASA）评分、埃利克斯豪泽合并症指数、终末期肝病模型钠（MELD-Na）、热缺血时间、输注的血小板和冷沉淀单位数以及术前血清白蛋白之间的关联。
663例肝移植受者符合纳入标准。术前血清白蛋白中位数为3.1[2.6 - 3.6]g/dL。术后ICU和住院LOS中位数分别为3.8[2.4 - 6.8]天和12[8 - 20]天。术前血清白蛋白可预测住院时间，但不能预测ICU住院时间（比值0.9[95%置信区间（CI）0.84 - 0.99]，P = 0.03，住院LOS；而比值0.92[95%CI 0.84 - 1.02]，P = 0.10，ICU住院LOS）。对于MELD-Na≤20的患者，ALBI 3级预测住院和ICU住院时间更长（比值1.40[95%CI 1.18 - 1.66]，P < 0.001，住院LOS；比值1.62[95%CI 1.32 - 1.99]，P < 0.001，ICU住院LOS）。对于MELD-Na>20的患者，这些关联不显著。
血清白蛋白可预测肝移植术后住院时间。ALBI 3级预测低MELD-Na受者的住院和ICU住院时间增加。
