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术前肝功能指标对原位肝移植大量输血的预测研究

Using Liver Function Indicators to Predict Massive Blood Transfusion in Orthotopic Liver Transplantation

    摘要
  • 摘要:
      目的  探讨术前肝功能指标对原位肝移植术中大量输血的预测作用，并建立预测模型。
      方法  回顾性分析2015年1月1日– 2021年6月30日四川大学华西医院肝脏外科行原位肝移植手术的607例患者相关资料，根据术中输注红细胞悬液量分为大量输注组（massive blood transfusion, MBT）及非大量输注组（non-massive blood transfusion, NMBT），采用单因素、多因素logistic回归对原位肝移植术中大量输血的危险因素进行分析，通过Hosmer-Lemeshow检验评价模型的校准度，受试者工作特征（receiver operating characteristic, ROC）曲线下面积（area under the curve, AUC）衡量模型的区分度。
      结果  logistic回归提示，丙氨酸转氨酶（alanine transaminase, ALT）、天冬氨酸转氨酶（aspartate transaminase, AST）、血清总胆红素（total bilirubin, TBIL）、血清直接胆红素（direct bilirubin, DBIL）、白蛋白（albumin, ALB）、child-Pugh评分与原位肝移植术中大量输血风险无相关性；血小板计数（platelet count, PLT）〔比值比（odds ratio, OR）=0.90，95%置信区间（confidence interval, CI）（0.09～0.19），P=0.02〕、国际标准化比值（international normalized ratio, INR）〔OR=19.43，95%CI（7.64～19.44），P<0.01〕、凝血酶原时间（prothrombin time, PT）〔OR=1.43，95%CI（1.25～1.63），P<0.01〕、活化部分凝血活酶时间（activated partial thromboplastin time, APTT）〔OR=0.92，95%CI（0.90～0.95），P<0.01〕是原位肝移植手术患者术中大量输血的危险因素，Hosmer-Lemeshow检验提示模型校准能力较好（χ2=9.06，P=0.48）；AUC为0.80，95%CI为0.77～0.83（P<0.01）。
      结论  基于原位肝移植患者术前PLT、INR 、PT、APTT建立预测模型可用于预测术中大量输血的风险。

     

    Abstract:
      Objective  To explore the predictive effect of preoperative liver function indicators for intraoperative massive blood transfusion in orthotopic liver transplantation and to establish a prediction model.
      Methods   We retrospectively analyzed the relevant data of 607 patients who underwent orthotopic liver transplantation in the Department of Liver Surgery, West China Hospital, Sichuan University between January 1, 2015 and June 30, 2021. According to the intraoperative transfusion volume of leukocyte-reduced red blood cells in additive solution, the patients were divided into a massive blood transfusion (MBT) group and a non-massive blood transfusion (NMBT) group. Univariate and multivariate logistic regressions were performed to analyze the risk factors of intraoperative MBT in orthotopic liver transplantation, the calibration of the predictive model was assessed by Hosmer-Lemeshow test, and the discrimination power of the predictive model was measured by area under the curve (AUC) of the receiver operating characteristic (ROC) curve.
      Results  According to the results of logistic regression, alanine transaminase (ALT), aspartate transaminase (AST), total bilirubin (TBIL), direct bilirubin (DBIL), albumin (ALB), and Child-Pugh score showed no correlation with the risk of MBT in orthotopic liver transplantation operation. Platelet count (PLT) (odds ratio OR=0.90, 95% confidence interval CI: 0.09-0.19, P=0.02), international normalized ratio (INR) (OR=19.43, 95% CI: 7.64-19.44, P<0.01), prothrombin time (PT) (OR=1.43, 95% CI: 1.25-1.63, P<0.01), and activated partial thromboplastin time (APTT) (OR=0.92, 95% CI: 0.90-0.95, P<0.01) were identified as the risk factors of intraoperative MBT in orthotopic liver transplantation. The Hosmer-Lemeshow test showed that the predictive model had good calibration (χ2=9.06, P=0.48) and discrimination power (AUC=0.80, 95% CI 0.766-0.834, P<0.01).
      Conclusion  A predictive model based on the preoperative PLT, INR, PT, and APTT of patients undergoing orthotopic liver transplantation was established and can be used to predict the risk of intraoperative MBT in liver transplantation patients.

     

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