Department of Anesthesia and Pain Medicine, Hospital for Sick Children, Toronto, Ontario, Canada.
University of Toronto, Faculty of Medicine, Toronto, Ontario, Canada.
Paediatr Anaesth. 2023 Nov;33(11):938-945. doi: 10.1111/pan.14736. Epub 2023 Aug 9.
Liver transplantation is the life-saving treatment for many end-stage pediatric liver diseases. The perioperative course, including surgical and anesthetic factors, have an important influence on the trajectory of this high-risk population. Given the complexity and variability of the immediate postoperative course, there would be utility in identifying risk factors that allow prediction of adverse outcomes and intensive care unit trajectories.
The aim of this study was to develop and validate a risk prediction model of prolonged intensive care unit length of stay in the pediatric liver transplant population.
This is a retrospective analysis of consecutive pediatric isolated liver transplant recipients at a single institution between April 1, 2013 and April 30, 2020. All patients under the age of 18 years receiving a liver transplant were included in the study (n = 186). The primary outcome was intensive care unit length of stay greater than 7 days.
Recipient and donor characteristics were used to develop a multivariable logistic regression model. A total of 186 patients were included in the study. Using multivariable logistic regression, we found that age < 12 months (odds ratio 4.02, 95% confidence interval 1.20-13.51, p = .024), metabolic or cholestatic disease (odds ratio 2.66, 95% confidence interval 1.01-7.07, p = .049), 30-day pretransplant hospital admission (odds ratio 8.59, 95% confidence interval 2.27-32.54, p = .002), intraoperative red blood cells transfusion >40 mL/kg (odds ratio 3.32, 95% confidence interval 1.12-9.81, p = .030), posttransplant return to the operating room (odds ratio 11.45, 95% confidence interval 3.04-43.16, p = .004), and major postoperative respiratory event (odds ratio 32.14, 95% confidence interval 3.00-343.90, p < .001) were associated with prolonged intensive care unit length of stay. The model demonstrates a good discriminative ability with an area under the receiver operative curve of 0.888 (95% confidence interval, 0.824-0.951).
We develop and validate a model to predict prolonged intensive care unit length of stay in pediatric liver transplant patients using risk factors from all phases of the perioperative period.
肝移植是许多终末期儿科肝病患者的救命治疗方法。围手术期过程，包括手术和麻醉因素，对这一高危人群的轨迹有重要影响。鉴于术后即刻病程的复杂性和可变性，确定可预测不良结局和重症监护病房轨迹的危险因素将具有实用性。
本研究旨在建立和验证小儿肝移植人群中重症监护病房住院时间延长的风险预测模型。
这是对 2013 年 4 月 1 日至 2020 年 4 月 30 日期间在一家单机构接受连续小儿孤立性肝移植的患者进行的回顾性分析。所有年龄在 18 岁以下接受肝移植的患者均纳入研究（n=186）。主要结局为重症监护病房住院时间超过 7 天。
使用多变量逻辑回归模型对患者和供体特征进行分析。共有 186 例患者纳入本研究。使用多变量逻辑回归，我们发现年龄<12 个月（比值比 4.02，95%置信区间 1.20-13.51，p=0.024）、代谢或胆汁淤积性疾病（比值比 2.66，95%置信区间 1.01-7.07，p=0.049）、移植前 30 天住院（比值比 8.59，95%置信区间 2.27-32.54，p=0.002）、术中红细胞输注>40 mL/kg（比值比 3.32，95%置信区间 1.12-9.81，p=0.030）、移植后返回手术室（比值比 11.45，95%置信区间 3.04-43.16，p=0.004）和主要术后呼吸事件（比值比 32.14，95%置信区间 3.00-343.90，p<0.001）与重症监护病房住院时间延长相关。该模型具有良好的区分能力，受试者工作特征曲线下面积为 0.888（95%置信区间，0.824-0.951）。
我们使用围手术期各阶段的危险因素建立并验证了一种预测小儿肝移植患者重症监护病房住院时间延长的模型。
