Risk stratification of adult patients undergoing orthotopic liver transplantation for fulminant hepatic failure
Risk stratification of adult patients undergoing orthotopic liver transplantation for fulminant hepatic failure
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DOI：
10.1097/01.tp.0000188149.90975.63
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发表时间：
2006-01-27
期刊：
影响因子：
6.2
通讯作者：
Goss, JA
中科院分区：
文献类型：
--
作者：
Barshes, NR;Lee, TC;Goss, JA
背景。原位肝移植（OLT）是治疗暴发性肝衰竭（FHF）的有效方法，但 FHF 患者的 OLT 后死亡率高于其他 OLT 适应症的患者。在当前的研究中，对一大批因 FHF 接受 OLT 的患者进行了评估，以开发和验证一个可用于估计 OLT 后患者生存率的系统。方法。通过 UNOS 数据库登记了 1988 年至 2003 年间在美国因 FHF 接受 OLT 的 1,457 名患者。该组被分为建模组 (n = 972) 和交叉验证组 (n = 486)。通过多变量回归分析，模型组用于识别与 OLT 后生存率显着相关的临床参数。该回归分析用于创建评分系统，随后在交叉验证组中进行评估。结果。通过多变量分析确定了四个危险因素：1）体重指数≥30 kg/m（2）； 2) 血清肌酐> 2.0 mg/dL； 3) 受赠者年龄>50岁； 4) 生命支持史。通过根据存在的风险因素数量进行评分，评分系统能够区分低风险患者（5 年生存率，81%）和高风险患者（5 年生存率，42%）。每增加一点，OLT 后死亡率的相对风险就会增加约 150%。结论。评分系统对交叉验证组进行风险分层，并准确预测 OLT 后的生存率。利用 OLT 之前现成的临床和人口统计信息的评分系统可能有助于预测 FHF OLT 后的生存概率。
Background. Orthotopic liver transplantation (OLT) is an effective treatment for fulminant hepatic failure (FHF), but postOLT mortality is higher for patients with FHF than for patients with other indications for OLT. In the current study, a large cohort of patients who underwent OLT for FHF was evaluated to develop and validate a system useful for estimating postOLT patient survival.Methods. The 1,457 patients who underwent OLT for FHF in the United States between 1988 and 2003 were enrolled through the UNOS database. This group was divided into a modeling group (n = 972) and a crossvalidation group (n = 486). With a multivariate regression analysis, the modeling group was used to identify clinical parameters that had a significant association with postOLT survival. This regression analysis was used to create a scoring system that was subsequently assessed in the crossvalidation group.Results. Four risk factors were identified with the multivariate analysis: 1) body mass index >= 30 kg/m(2); 2) serum creatinine > 2.0 mg/dL; 3) recipient age > 50 years old; and 4) history of life support. By assigning points based on the number of risk factors present, the scoring system was able to differentiate between low-risk patients (5-year survival, 81%) and high-risk patients (5-year survival, 42%). The relative risk of postOLT mortality increased by approximately 150% for each additional point.Conclusion. The scoring system risk-stratified the crossvalidation group and accurately predicted postOLT survival. A scoring system utilizing clinical and demographic information readily available prior to OLT may help predict the probability of survival after OLT for FHF.