Predictors of long-term mortality in patients with cirrhosis undergoing cardiac surgery.
Predictors of long-term mortality in patients with cirrhosis undergoing cardiac surgery.
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发表时间：
2015-08
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通讯作者：
J. Lopez-Delgado;F. Esteve;C. Javierre;H. Torrado;M. L. Carrio;D. Rodríguez-Castro;E. Farrero;J. Lluís Ventura;R. Mañez
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作者：
J. Lopez-Delgado;F. Esteve;C. Javierre;H. Torrado;M. L. Carrio;D. Rodríguez-Castro;E. Farrero;J. Lluís Ventura;R. Mañez
目的对接受心脏手术的肝硬变患者的长期结局知之甚少。这项研究的目的是确定手术前和术后死亡的危险因素，并确定最好的预测长期结果的因素。方法对2004年1月至2009年1月连续58例需要心脏手术的肝硬变患者进行前瞻性研究。死亡7例(12%)。全组随访至2012年11月，平均(46±28)个月。通常在入院时和术后24 h内测量的变量与心脏手术评分(Parsonnet，EuroSCORE)、肝脏评分(Child-Turcotte-Pugh，终末期肝病模型、英国终末期肝病评分)和ICU评分(急性生理学和慢性健康评估II和III、简化急性生理学评分II和III、序贯器官衰竭评估)一起进行评估。结果随访期间死亡12例(23.5%)，ChildA级6例，B级6例。单因素分析显示，存活与死亡的预后相关变量为入院后24 h动脉血乳酸(1.7±0.4vs.2.1±0.7 mmol.L(-1)，P=0.03)和入院后24 h尿量(2029±512 vs.1575±627mL.P=0.03)。受试者操作特征曲线显示简化急性生理学评分对远期预后的预测价值最高(AUC77.4±0.76%；敏感度83.3%；特异度64.9%，P=0.005)。多因素分析显示简化急性生理学评分III评分(P=0.02)和24小时尿量(P=0.02)是影响远期预后的独立因素。长期生存率A级82.4%，B级47.6%，C级33.3%(P=0.001)。结论在需要心脏手术的肝硬变患者中，长期生存是比短期生存更有价值的预后指标。头24小时的尿量可能是这些患者长期预后的有价值的预测指标。简化的急性生理学评分III也很有用。
AIM Little is known regarding the long-term outcome in cirrhotic patients undergoing cardiac surgery. The objective of this study was to identify preoperative and postoperative mortality risk factors and to determine the best predictors of long-term outcome. METHODS Fifty-eight consecutive cirrhotic patients requiring cardiac surgery between January 2004 and January 2009 were prospectively studied at our institution. Seven patients (12%) died. A complete follow-up was performed in the whole survival group until November 2012 (mean 46±28 months). Variables usually measured on admission and during the first 24 h of the postoperative period were evaluated together with cardiac surgery scores (Parsonnet, EuroSCORE), liver scores (Child-Turcotte-Pugh, Model for End-Stage Liver Disease, United Kingdom End-Stage Liver Disease score), and ICU scores (Acute Physiology and Chronic Health Evaluation II and III, Simplified Acute Physiology Score II and III, Sequential Organ Failure Assessment). RESULTS Twelve patients (23.5%) died during follow-up; six were Child class A and six class B. Comparing survivors vs. non-survivors using univariate analysis, variables associated with better long-term outcome were lower arterial lactate 24 h after admission (1.7±0.4 vs. 2.1±0.7 mmol·L(-1), P=0.03) and higher urine output in the first 24 h (2029±512 vs. 1575±627 mL, P=0.03). The receiver operating characteristic curve showed that the Simplified Acute Physiology Score III score had the best predictive value for long-term outcome (AUC: 77.4±0.76%; sensitivity: 83.3%; specificity: 64.9%, P=0.005). Multivariate analysis identified Simplified Acute Physiology Score III score (P=0.02) and urine output in the first 24 h (P=0.02) as independent factors associated with long-term outcome. Long-term survival was 82.4% for Child A, 47.6% for Child B and 33.3% for Child C (P=0.001). CONCLUSION Long-term survival in cirrhotic patients requiring cardiac surgery is a more valuable prognostic measure than short-term survival. Urine output in the first 24 h may be a valuable predictor of long-term outcome in these patients. The Simplified Acute Physiology Score III is also useful.