Pétursson Ingi, Amabile Andrea, Degife Ellelan, Morrison Alyssa, Waldron Christina, Bin Mahmood Syed Usman, Ragnarsson Sigurður, Krane Markus, Geirsson Arnar
Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavík, Iceland.
Division of Cardiac Surgery, Yale School of Medicine, New Haven, Conn.
JTCVS Open. 2023 Jul 16;16:532-539. doi: 10.1016/j.xjon.2023.07.001. eCollection 2023 Dec.
Liver disease (LD) is considered a risk factor for inferior outcomes in general and cardiac surgery, yet current cardiac surgery risk estimators exclude LD, and literature on the topic remains scant. We sought to evaluate whether the presence of advanced LD is associated with inferior outcomes following cardiac surgery.
This single-center, retrospective, observational study included 285 patients diagnosed with LD who underwent cardiac surgery in 2010 to 2020. The cohort contained 3 groups, Child-Turcotte-Pugh (CTP) class A (n = 219), CTP early-class B (n = 34), and CTP advanced-class B (n = 32). A model for end-stage liver disease score of 12.7 points (determined using a receiver-operating characteristic curve analysis on 30-day mortality) dichotomized class B into early- and advanced-groups. Univariate and multivariate logistic regression analyses were performed to identify predictors of 30-day mortality.
Patients in CTP advanced-class B had the longest length of stay (14 days), highest incidence of prolonged ventilation (46.9%), renal failure (21.9%), 30-day mortality (18.8%), and in-hospital mortality (18.8%). Incidence of ≥1 postoperative complication was higher in CTP advanced-class B (59.4%), compared with CTP class A (37.9%) and CTP early-class B (38.2%). Multivariate logistic regression analysis demonstrated that female sex (odds ratio, 3.01; 95% CI, 1.07-8.77; = .037) and peripheral vascular disease (odds ratio, 4.01; 95% CI, 1.33-12.2; = .013) were independent predictors of 30-day mortality in patients with advanced LD.
Severity of LD influences perioperative outcomes following cardiac surgery. Our data suggest that patients in CTP class A and selected patients in CTP class B (model for end-stage liver disease score <12.7) can undergo surgery with acceptable risk.
肝病（LD）被认为是普通外科手术和心脏手术预后较差的一个危险因素，但目前的心脏手术风险评估工具未将LD纳入，且关于该主题的文献仍然匮乏。我们试图评估晚期LD的存在是否与心脏手术后较差的预后相关。
这项单中心、回顾性、观察性研究纳入了2010年至2020年期间接受心脏手术的285例诊断为LD的患者。该队列包含3组，Child-Turcotte-Pugh（CTP）A级（n = 219）、CTP早期B级（n = 34）和CTP晚期B级（n = 32）。采用终末期肝病模型评分12.7分（通过对30天死亡率进行受试者工作特征曲线分析确定）将B级分为早期和晚期组。进行单因素和多因素逻辑回归分析以确定30天死亡率的预测因素。
CTP晚期B级患者的住院时间最长（14天），长时间通气发生率最高（46.9%）、肾衰竭发生率最高（21.9%）、30天死亡率最高（18.8%）和院内死亡率最高（18.8%）。CTP晚期B级患者术后≥1种并发症的发生率（59.4%）高于CTP A级（37.9%）和CTP早期B级（38.2%）。多因素逻辑回归分析表明，女性（比值比，3.01；95%置信区间，1.07 - 8.77；P = 0.037）和外周血管疾病（比值比，4.01；95%置信区间，1.33 - 12.2；P = 0.013）是晚期LD患者30天死亡率的独立预测因素。
LD的严重程度影响心脏手术后的围手术期结局。我们的数据表明，CTP A级患者以及部分CTP B级患者（终末期肝病模型评分<12.7）可以接受风险可接受的手术。
