Perioperative Delta Sodium and Post-Liver Transplant Neurological Complications in Liver Transplant Recipients.
Perioperative Delta Sodium and Post-Liver Transplant Neurological Complications in Liver Transplant Recipients.
复制标题
肝移植受者围手术期 Delta 钠和肝移植后神经并发症。
DOI：
10.1097/tp.0000000000004102
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发表时间：
2022
期刊：
影响因子：
6.2
通讯作者：
Lai,JenniferC
中科院分区：
文献类型：
--
作者：
Berry,Kacey;Copeland,Timothy;Ku,Elaine;Lai,JenniferC
背景：肝移植（LT）前低钠血症增加失代偿期肝硬化患者LT后神经系统并发症的风险，但LT前后钠的变化对中枢神经系统（CNS）后遗症风险的影响程度尚不清楚。我们评估了LT住院期间LT前后δ钠水平与CNS并发症患病率之间的关系。我们对1265例接受LT（2011-2020年）的肝硬化成人患者进行了回顾性单中心图表分析。Delta钠定义为LT后48 h内最高钠和LT前7 d内最低钠之间的差异。主要结局是同一住院期间LT后CNS事件-脑病、谵妄、癫痫发作、昏迷、渗透性脱髓鞘综合征或其他精神状态改变，由国际疾病分类代码确定。次要结局是LT后住院时间（LOS）。Logistic回归模型之间的关联δ钠和LT后CNS outcomes; negative binomial regression modeled LOS.Results.Median age was 59 y，36%为女性，and median Model for End-Stage Liver Disease score was 20.中位δ钠为8 mmol/L（四分位距，5-11）。194例（15%）发生LT后CNS并发症。在多变量分析中，控制包括LT前低钠血症在内的混杂因素，δ钠每增加5 mmol/L，CNS并发症的几率增加47%（95%置信区间，22%-77%）。在调整回归中，δ钠还与LOS增加7%相关（95%置信区间，3%-12%）。结论：具有较高围手术期δ钠变化的成人LT受者显示出更高的LT后CNS并发症风险，即使在调整了LT前钠后。LT接受者，即使是那些LT前低钠血症，可能受益于维持稳定的血清钠水平，以尽量减少LT后CNS并发症。
Background.Hyponatremia before liver transplant (LT) increases risk of post-LT neurological complications in patients with decompensated cirrhosis, but it is unknown to what extent change in sodium from pre-to post-LT influences risk of central nervous system (CNS) sequelae. We assessed the relationship between pre-to post-LT delta sodium and prevalence of CNS complications during LT hospitalization.Methods.We performed retrospective single-center chart review of 1265 adults with cirrhosis who underwent LT (2011–2020). Delta sodium is defined as the difference between maximum sodium within 48 h post-LT and lowest sodium within 7 d pre-LT. Primary outcomes are post-LT CNS events during same hospitalization—encephalopathy, delirium, seizure, coma, osmotic demyelination syndrome, or other altered mental status, determined by International Classification of Diseases codes. Secondary outcome is length of hospital stay post-LT (LOS). Logistic regression modeled association between delta sodium and post-LT CNS outcomes; negative binomial regression modeled LOS.Results.Median age was 59 y, 36% were female, and median Model for End-Stage Liver Disease score was 20. Median delta sodium was 8 mmol/L (interquartile range, 5–11). One hundred ninety-four (15%) experienced post-LT CNS complications. In multivariable analysis, controlling for confounders including pre-LT hyponatremia, every 5 mmol/L increase in delta sodium associated with 47% greater odds of CNS complication (95% confidence interval, 22%-77%). Delta sodium also associated with 7% increased LOS in adjusted regression (95% confidence interval, 3%-12%).Conclusions.Adult LT recipients with higher perioperative delta sodium shifts displayed a higher risk of post-LT CNS complications, even after adjusting for pre-LT sodium. LT recipients, even those with pre-LT hyponatremia, may benefit from maintenance of stable serum sodium levels to minimize post-LT CNS complications.