Liver transplantation in the critically ill: a multicenter Canadian retrospective cohort study.
Liver transplantation in the critically ill: a multicenter Canadian retrospective cohort study.
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DOI：
10.1186/cc12508
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发表时间：
2013-02-09
期刊：
影响因子：
--
通讯作者：
Canadian Liver Failure Study Group
中科院分区：
文献类型：
--
作者：
Karvellas CJ;Lescot T;Goldberg P;Sharpe MD;Ronco JJ;Renner EL;Vahidy H;Poonja Z;Chaudhury P;Kneteman NM;Selzner M;Cook EF;Bagshaw SM;Canadian Liver Failure Study Group
等待肝移植（LT）的重症肝硬化患者通常会获得器官分配的优先权。确定最有可能受益的患者至关重要。本研究的目的是检查序贯器官衰竭评估（SOFA）评分是否可以预测危重患者接受LT的90天死亡率，以及是否可以预测等待LT的危重肝硬化患者接受LT。我们进行了一项多中心回顾性队列研究，包括两个数据集：（a）2000年至2009年期间，加拿大5个肝移植中心所有需要在接受肝移植前入住深切治疗部的肝硬化危重症患者（一个研究中心，1990年至2009年），和（B）来自ICU接受LT的重症肝硬化患者（n = 115）和已登记但死亡前未接受LT的患者（n = 106），来自两个中心，其中有完整的数据。在第一个数据集中，纳入了198例接受LT的重症肝硬化患者（平均（SD）年龄53（10）岁，66%为男性，终末期肝病（MELD）的中位数（IQR）模型为34（26-39））。ICU入院、48小时和LT时的平均（SD）SOFA评分分别为12.5（4）、13.0（5）和14.0（4）。90天时的存活率为84%（n = 166）。在多变量分析中，只有年龄较大与90天生存率降低独立相关（比值比（OR），1.07; 95%CI，1.01 - 1.14; P = 0.013）。SOFA评分不能预测任何时间的90天死亡率。在第二个数据集中，47.9%（n = 106）的肝硬化患者在ICU等待LT时死亡。在多变量分析中，入院后48小时SOFA较高与接受LT的概率较低独立相关（OR，0.89; 95%CI，0.82至0.97; P = 0.006）。当在最终模型中包括48小时的血清乳酸和SOFA时，乳酸升高（48小时）也与接受LT的可能性降低显著相关（0.32; 0.17至0.61; P = 0.001）。SOFA在预测危重肝硬化患者LT后90天生存率方面似乎较差，但SOFA评分较高和ICU入院后48小时乳酸升高与接受LT的可能性较低相关。接受LT的老年危重肝硬化患者（60岁以上）90天生存率较差，应谨慎考虑LT。
Critically ill cirrhosis patients awaiting liver transplantation (LT) often receive prioritization for organ allocation. Identification of patients most likely to benefit is essential. The purpose of this study was to examine whether the Sequential Organ Failure Assessment (SOFA) score can predict 90-day mortality in critically ill recipients of LT and whether it can predict receipt of LT among critically ill cirrhosis listed awaiting LT. We performed a multicenter retrospective cohort study consisting of two datasets: (a) all critically-ill cirrhosis patients requiring intensive care unit (ICU) admission before LT at five transplant centers in Canada from 2000 through 2009 (one site, 1990 through 2009), and (b) critically ill cirrhosis patients receiving LT from ICU (n = 115) and those listed but not receiving LT before death (n = 106) from two centers where complete data were available. In the first dataset, 198 critically ill cirrhosis patients receiving LT (mean (SD) age 53 (10) years, 66% male, median (IQR) model for end-stage liver disease (MELD) 34 (26-39)) were included. Mean (SD) SOFA scores at ICU admission, at 48 hours, and at LT were 12.5 (4), 13.0 (5), and 14.0 (4). Survival at 90 days was 84% (n = 166). In multivariable analysis, only older age was independently associated with reduced 90-day survival (odds ratio (OR), 1.07; 95% CI, 1.01 to 1.14; P = 0.013). SOFA score did not predict 90-day mortality at any time. In the second dataset, 47.9% (n = 106) of cirrhosis patients listed for LT died in the ICU waiting for LT. In multivariable analysis, higher SOFA at 48 hours after admission was independently associated with lower probability of receiving LT (OR, 0.89; 95% CI, 0.82 to 0.97; P = 0.006). When including serum lactate and SOFA at 48 hours in the final model, elevated lactate (at 48 hours) was also significantly associated with lower likelihood of receiving LT (0.32; 0.17 to 0.61; P = 0.001). SOFA appears poor at predicting 90-day survival in critically ill cirrhosis patients after LT, but higher SOFA score and elevated lactate 48 hours after ICU admission are associated with a lower probability receiving LT. Older critically ill cirrhosis patients (older than 60) receiving LT have worse 90-day survival and should be considered for LT with caution.
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影响因子：
4.6
作者：
Thuluvath, Paul J.;Maheshwari, Anurag;Segev, Dorry L.
通讯作者：
Segev, Dorry L.
影响因子：
7.6
作者：
Cholongitas, E;Senzolo, M;Burroughs, AK
通讯作者：
Burroughs, AK
影响因子：
25.7
作者：
Shawcross, Debbie L.;Austin, Mark J.;Wendon, Julia A.
通讯作者：
Wendon, Julia A.
DOI：
10.1186/cc9068
发表时间：
2010
期刊：
Critical care (London, England)
影响因子：
--
作者：
Oberkofler CE;Dutkowski P;Stocker R;Schuepbach RA;Stover JF;Clavien PA;Béchir M
通讯作者：
Béchir M
影响因子：
2.9
作者：
Tsai, MH;Chen, YC;Chen, PC
通讯作者：
Chen, PC