Lobo Suzana Margareth, Paulucci Pedro Saggioro, Tavares Lucas Martins, Luckemeyer Graziela Benardin, Machado Luana Fernandes, Elias de Oliveira Neymar, Minhoto Silvia Prado, Alves Silva Rita Cassia, da Silva Renato Ferreira, Freitas Marlon Souza, Lobo Francisco Ricardo Marques, Berger-Estilita Joana
Hospital de Base da Faculdade de Medicina de São José do Rio Preto (FAMERP), Divisão de Terapia Intensiva, São José do Rio Preto, SP, Brazil.
Hospital de Base da Faculdade de Medicina de São José do Rio Preto (FAMERP), Divisão de Terapia Intensiva, São José do Rio Preto, SP, Brazil.
Braz J Anesthesiol. 2025 May-Jun;75(3):844619. doi: 10.1016/j.bjane.2025.844619. Epub 2025 Apr 4.
This study evaluates the impact of Fluid Balance (FB) patterns on outcomes after Orthotopic Liver Transplantation (OLT). It hypothesizes that deviations from optimal FB increase morbidity.
In a single-center cohort post hoc analysis of 73 post-OLT patients, FB was categorized into three groups based on cumulative FB at 72 hours: Lowest (negative FB), Intermediate (0-2000 mL), and Highest (> 2000 mL). We analyzed Sequential Organ Failure Assessment (SOFA) scores, mortality rates, and causes of death. Logistic regression identified mortality predictors.
The Highest FB group had the highest SOFA scores and mortality (Group "Lo": 18.2%, Group "In": 8.6%, Group "Hi": 40.5%, p = 0.009). A U-shaped relationship between FB and hospital mortality was observed, with extremes of FB associated with higher mortality. Cumulative FB independently predicted all-cause mortality with a 29.5% increase in the risk of death. FB on day 3 also predicted all-cause mortality, increasing the risk by 83.9%. Furthermore, FB on day 1 was linked to a 134.5% increase in the risk of death due to primary non-function of the liver. SOFA score strongly predicted all-cause mortality, with a one-point increase associated with a 98.8% to 114.7% increase in mortality risk.
These findings suggest that both negative and positive extremes of FB are associated with worse outcomes after OLT, reinforcing the U-shaped relationship between FB and mortality. Our results underscore the importance of balanced fluid management, particularly in the early postoperative period. The study highlights the need for individualized FB strategies to optimize organ function and reduce mortality. The use of SOFA scores as a predictor of mortality further emphasizes the importance of liver function monitoring in post-OLT patients. However, the single-centre design and convenience sample limit the generalizability of our findings, necessitating validation through multicenter studies.
Our study provides valuable insights into the relationship between FB patterns and mortality in OLT patients. Both negative and positive extremes of FB are associated with higher mortality, suggesting the need for a balanced and individualized fluid management approach. The strong predictive value of SOFA scores for all-cause mortality highlights the importance of early and continuous monitoring of liver function. Future multicenter randomized controlled trials are needed to validate these findings and develop optimized fluid management protocols for OLT patients.
本研究评估了液体平衡（FB）模式对原位肝移植（OLT）术后结局的影响。研究假设与最佳FB的偏差会增加发病率。
在一项对73例OLT术后患者的单中心队列事后分析中，根据72小时时的累积FB将FB分为三组：最低（负FB）、中等（0 - 2000 mL）和最高（> 2000 mL）。我们分析了序贯器官衰竭评估（SOFA）评分、死亡率和死亡原因。逻辑回归确定了死亡率预测因素。
最高FB组的SOFA评分和死亡率最高（“低”组：18.2%，“中”组：8.6%，“高”组：40.5%，p = 0.009）。观察到FB与医院死亡率之间呈U形关系，FB的极端值与较高的死亡率相关。累积FB独立预测全因死亡率，死亡风险增加29.5%。第3天的FB也预测全因死亡率，风险增加83.9%。此外，第1天的FB与肝原发性无功能导致的死亡风险增加134.5%相关。SOFA评分强烈预测全因死亡率，评分每增加1分，死亡风险增加98.8%至114.7%。
这些发现表明，FB的负极端值和正极端值均与OLT术后更差的结局相关，强化了FB与死亡率之间的U形关系。我们的结果强调了平衡液体管理的重要性，特别是在术后早期。该研究强调了需要个性化的FB策略以优化器官功能并降低死亡率。使用SOFA评分作为死亡率预测指标进一步强调了OLT术后患者肝功能监测的重要性。然而，单中心设计和便利样本限制了我们研究结果的普遍性，需要通过多中心研究进行验证。
我们的研究为OLT患者中FB模式与死亡率之间的关系提供了有价值的见解。FB的负极端值和正极端值均与较高的死亡率相关，表明需要一种平衡且个性化的液体管理方法。SOFA评分对全因死亡率的强预测价值凸显了早期和持续监测肝功能的重要性。未来需要多中心随机对照试验来验证这些发现，并为OLT患者制定优化的液体管理方案。
