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术后早期肝功能异常的危险因素及预测模型

Risk factors and predictive modeling of early postoperative liver function abnormalities.

作者信息

Zhong Lin, Wang Hao-Yuan, Li Xiao-Na, Ling Qiong, Hao Ning, Li Xiang-Yu, Zhao Gao-Feng, Liao Min

机构信息

Second Clinical Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510120, Guangdong Province, China.

Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510120, Guangdong Province, China.

出版信息

World J Hepatol. 2025 Aug 27;17(8):108333. doi: 10.4254/wjh.v17.i8.108333.

Abstract

BACKGROUND

Research has shown that several factors can influence postoperative abnormal liver function; however, most studies on this issue have focused specifically on hepatic and cardiac surgeries, leaving limited research on contributing factors in other types of surgeries.

AIM

To identify the risk factors for early postoperative abnormal liver function in multiple surgery types and construct a risk prediction model.

METHODS

This retrospective cohort study involved 3720 surgical patients from 5 surgical departments at Guangdong Provincial Hospital of Traditional Chinese Medicine. Patients were divided into abnormal ( = 108) and normal ( = 3612) groups based on liver function post-surgery. Univariate analysis and LASSO regression screened variables, followed by logistic regression to identify risk factors. A prediction model was constructed based on the variables selected logistic regression. The goodness-of-fit of the model was evaluated using the Hosmer-Lemeshow test, while discriminatory ability was measured by the area under the receiver operating characteristic curve. Calibration curves were plotted to visualize the consistency between predicted probabilities and observed outcomes.

RESULTS

The key factors contributing to abnormal liver function after surgery include elevated aspartate aminotransferase and alanine aminotransferase levels and reduced platelet counts pre-surgery, as well as the sevoflurane use during the procedure, among others.

CONCLUSION

The above factors collectively represent notable risk factors for postoperative liver function injury, and the prediction model developed based on these factors demonstrates strong predictive efficacy.

摘要

背景

研究表明,多种因素可影响术后肝功能异常;然而,关于这一问题的大多数研究都特别关注肝脏和心脏手术,对其他类型手术的影响因素研究有限。

目的

确定多种手术类型术后早期肝功能异常的危险因素,并构建风险预测模型。

方法

这项回顾性队列研究纳入了广东省中医院5个外科科室的3720例手术患者。根据术后肝功能将患者分为异常组(n = 108)和正常组(n = 3612)。单因素分析和LASSO回归筛选变量,随后进行逻辑回归以识别危险因素。基于逻辑回归选择的变量构建预测模型。使用Hosmer-Lemeshow检验评估模型的拟合优度,同时通过受试者操作特征曲线下面积测量区分能力。绘制校准曲线以直观显示预测概率与观察结果之间的一致性。

结果

术后肝功能异常的关键因素包括术前天冬氨酸转氨酶和丙氨酸转氨酶水平升高、血小板计数降低,以及手术过程中使用七氟烷等。

结论

上述因素共同构成术后肝功能损伤的显著危险因素,基于这些因素建立的预测模型具有较强的预测效能。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5e50/12400440/34cd198a94f9/wjh-17-8-108333-g001.jpg

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