Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA; Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA.
Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA; Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.
J Clin Anesth. 2024 Sep;96:111486. doi: 10.1016/j.jclinane.2024.111486. Epub 2024 May 9.
Evaluation of the association between intraoperative hypotension (IOH) and important postoperative outcomes after liver transplant such as incidence and severity of acute kidney injury (AKI), MACE and early allograft dysfunction (EAD).
Retrospective, single institution study.
Operating room.
1576 patients who underwent liver transplant in our institution between January 2005 and February 2022.
IOH was measured as the time, area under the threshold (AUT), or time-weighted average (TWA) of mean arterial pressure (MAP) less than certain thresholds (55,60 and 65 mmHg). Associations between IOH exposures and AKI severity were assessed via proportional odds models. The odds ratio from the proportional odds model estimated the relative odds of having higher stage of AKI for higher exposure to IOH. Associations between exposures and MACE and EAD were assessed through logistic regression models. Potential confounding variables including patient baseline and surgical characteristics were adjusted for all models.
The primary analysis included 1576 surgeries that met the inclusion and exclusion criteria. Of those, 1160 patients (74%) experienced AKI after liver transplant surgery, with 780 (49%), 248(16%), and 132 (8.4%) experiencing mild, moderate, and severe injury, respectively. No significant association between hypotension exposure and postoperative AKI (yes or no) nor severity of AKI was observed. The odds ratios (95% CI) of having more severe AKI were 1.02 (0.997, 1.04) for a 50-mmHg·min increase in AUT of MAP <55 mmHg (P = 0.092); 1.03 (0.98, 1.07) for a 15-min increase in time spent under MAP <55 mmHg (P = 0.27); and 1.24 (0.98, 1.57) for a 1 mmHg increase in TWA of MAP <55 mmHg (P = 0.068). The associations between IOH and the incidence of MACE or EAD were not significant.
Our results did not show the association between IOH and investigated outcomes.
评估术中低血压（IOH）与肝移植后重要术后结局之间的关联，如急性肾损伤（AKI）的发生率和严重程度、主要不良心血管事件（MACE）和早期移植物功能障碍（EAD）。
回顾性、单中心研究。
手术室。
2005 年 1 月至 2022 年 2 月期间在我院接受肝移植的 1576 例患者。
IOH 被测量为平均动脉压（MAP）低于某些阈值（55、60 和 65mmHg）的时间、阈值下面积（AUT）或时间加权平均（TWA）。通过比例优势模型评估 IOH 暴露与 AKI 严重程度之间的关联。比例优势模型估计的比值比估计了更高的 IOH 暴露水平下 AKI 更高阶段的相对可能性。通过逻辑回归模型评估暴露与 MACE 和 EAD 之间的关联。所有模型均调整了患者基线和手术特征等潜在混杂变量。
主要分析包括符合纳入和排除标准的 1576 例手术。其中，1160 例（74%）患者在肝移植手术后发生 AKI，其中 780 例（49%）、248 例（16%）和 132 例（8.4%）分别发生轻度、中度和重度损伤。未观察到低血压暴露与术后 AKI（是或否）或 AKI 严重程度之间存在显著关联。AUT 中 MAP＜55mmHg 每增加 50mmHg·min，AKI 更严重的比值比（95%CI）为 1.02（0.997，1.04）（P=0.092）；MAP＜55mmHg 下时间每增加 15min，AKI 更严重的比值比为 1.03（0.98，1.07）（P=0.27）；MAP＜55mmHg 下 TWA 每增加 1mmHg，AKI 更严重的比值比为 1.24（0.98，1.57）（P=0.068）。IOH 与 MACE 或 EAD 发生率之间的关联不显著。
我们的结果并未显示 IOH 与研究结果之间的关联。
