Primary graft failure following lung transplantation -: Predictive factors of mortality
Primary graft failure following lung transplantation -: Predictive factors of mortality
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DOI：
10.1378/chest.121.6.1876
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发表时间：
2002-06-01
期刊：
影响因子：
9.6
通讯作者：
Mal, H
中科院分区：
文献类型：
--
作者：
Thabut, G;Vinatier, I;Mal, H
研究目的：评估肺移植（LTx）后原发性移植物衰竭（PGF）患者死亡率的发生率、结局和早期预测因素，并制定损伤严重程度评分，以准确预测这些患者的ICU死亡率。设计：回顾性队列分析。设置：巴黎的两个LTx中心。患者：259例在12年内接受LTx的患者。测量和结果：131例患者（50.6%）符合PGF标准：LTx后前3天内的放射学移植物浸润与气体交换受损相关（PaO 2/吸入氧分数比值< 300 mm Hg）。该综合征与机械通气持续时间（9.1 +/- 1天vs 3.1 +/- 0.6天，平均值+/- SD; p < 0.001）和ICU死亡率（29% vs 10.9%; p < 0.01）增加相关。PGF患者被随机分配到发育（n = 85）和验证（n = 46）样本。使用逻辑回归分析，发现四个变量与这些患者的ICU死亡率相关：年龄，气体交换受损程度，移植物缺血时间和严重的早期血流动力学衰竭。缺血/再灌注损伤严重程度评分使用这四个变量。模型校准是良好的发展和验证样本，是模型的歧视（受试者工作特征曲线下的面积，分别为0.93和0.85，）。结论：前列腺素F以下LTx是一个常见的事件，具有显着的ICU发病率和死亡率。我们证明，四个简单的因素可以预测ICU死亡率具有良好的准确性。
Study objectives: To assess incidence, outcome, and early predictors of mortality for patients with primary graft failure (PGF) following lung transplantation (LTx), and to develop an injury severity score able to accurately predict ICU mortality for these patients.Design: Retrospective cohort analysis.Setting: Two LTx centers in Paris.Patients: Two hundred fifty-nine patients who underwent LTx over a 12-year period.Measurements and results: One hundred thirty-one patients (50.6%) met PGF criteria: radiographic graft infiltrate within the first 3 days following LTx associated with gas exchange impairment (Pao2/fraction of inspired oxygen ratio < 300 mm Hg). This syndrome was associated with an increased duration of mechanical ventilation (9.1 +/- 1 days vs 3.1 +/- 0.6 days, mean +/- SD; p < 0.001) and ICU mortality (29% vs 10.9%; p < 0.01). The patients with PGF were randomly assigned to developmental (n = 85) and validation (n = 46) samples. Using logistic regression analysis, four variables were found associated with ICU mortality in these patients: age, degree of gas exchange impairment, graft ischemic time, and severe early hemodynamic failure. An ischemia/reperfusion injury severity score was derived using these four variables. Model calibration was good in the developmental and validation samples, as was model discrimination (area under receiver operating characteristic curves, 0.93 and 0.85, respectively).Conclusion: PGF following LTx is a frequent event, with significant ICU morbidity and mortality. We demonstrate that four simple factors allow prediction of ICU mortality with good accuracy.