Coeckelenbergh Sean, Drouard Leonard, Ickx Brigitte, Lucidi Valerio, Germanova Desislava, Desebbe Olivier, Duhaut Lea, Moussa Maya, Naili Salima, Vibert Eric, Samuel Didier, Duranteau Jacques, Vincent Jean-Louis, Rinehart Joseph, Van der Linden Philippe, Joosten Alexandre
Department of Anesthesiology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium; Department of Anesthesiology, Paul Brousse Hospital, Université Paris-Saclay, Assistance Publique Hôpitaux de Paris (APHP), Villejuif, France.
Department of Anesthesiology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium.
Transplant Proc. 2023 Jan-Feb;55(1):147-152. doi: 10.1016/j.transproceed.2022.11.004. Epub 2023 Jan 7.
Liver transplant patients who develop hyperlactatemia are at increased risk of postoperative morbidity and short-term mortality, but there are few data on longer-term outcomes. We therefore investigated if arterial lactate concentration obtained immediately after surgery, at the time of admission to the intensive care unit (ICU), was associated with 1-year mortality.
In this retrospective cohort study, all patients who underwent liver transplant surgery from a deceased donor between September 2013 and December 2019 were screened for inclusion. Patients who underwent combined transplantation surgery and those with a history of previous liver transplantation (ie, redo surgery) were not included. Logistic regression modeling included univariate and multivariate analyses. Receiver operating characteristic curves and areas under the curves were calculated. Lactate thresholds and association with outcome were analyzed for specificity, sensitivity, and Youden's index.
Of 226 patients included, 18.4% died within 1 year of liver transplantation. Immediate postoperative lactate concentration was independently associated with 1-year mortality with an adjusted odds ratio of 1.35 (95% CI 1.16-1.59; P < .001) per mmol/L increase in lactate and an area under the curve of 0.80 (95% CI 0.72-0.87; P < .001). A lactate concentration of 2.25 mmol/L (cutoff determined using Youden's index) was associated with increased 1-year mortality with a sensitivity of 0.71 and a specificity of 0.72.
Increased arterial lactate concentration on admission to the intensive care unit immediately after orthotopic liver transplantation is independently associated with increased 1-year mortality.
发生高乳酸血症的肝移植患者术后发病和短期死亡风险增加，但关于长期预后的数据较少。因此，我们研究了术后即刻、重症监护病房（ICU）入院时测得的动脉血乳酸浓度是否与1年死亡率相关。
在这项回顾性队列研究中，对2013年9月至2019年12月期间接受已故供体肝移植手术的所有患者进行筛查以纳入研究。接受联合移植手术的患者以及既往有肝移植史（即再次手术）的患者被排除在外。逻辑回归模型包括单变量和多变量分析。计算受试者工作特征曲线和曲线下面积。分析乳酸阈值及其与预后的关联，以确定特异性、敏感性和尤登指数。
纳入的226例患者中，18.4%在肝移植后1年内死亡。术后即刻乳酸浓度与1年死亡率独立相关，乳酸每增加1 mmol/L，调整后的优势比为1.35（95%CI 1.16 - 1.59；P <.001），曲线下面积为0.80（95%CI 0.72 - 0.87；P <.001）。乳酸浓度为2.25 mmol/L（使用尤登指数确定的临界值）与1年死亡率增加相关，敏感性为0.71，特异性为0.72。
原位肝移植术后即刻重症监护病房入院时动脉血乳酸浓度升高与1年死亡率增加独立相关。
