The establishment of predictive model and influencing factors of major adverse cardiovascular events during perioperative period of adult liver transplantation

doi:10.3877/cma.j.issn.1674-3903.2024.04.004

Abstract

Abstract:

Objective

To investigate the influencing factors and prognosis analysis of major adverse cardiovascular events (MACE) during perioperative period of adult liver transplantation, and to create a nomogram predict risk model.

Methods

The clinical data of 545 adult recipients who underwent liver transplantation in the Affiliated Hospital of Qingdao University from January 2016 to December 2020 were retrospectively analyzed. According to the occurrence of MACE during the perioperative period, the patients were divided into MACE group (57 cases) and non-MACE group(488 cases). The perioperative data of the two groups were compared. Survival curves were plotted using the Kaplan-Meier method and compared using the log-rank test. According to the independent risk factors shown by logistics regression analysis, nomograms were constructed, and receiver operating characteristic (ROC) curves were used to determine the predictive value of nomograms.

Results

Compared with the non-MACE group, recipients in MACE group were older, had higher preoperative model for end-stage liver disease (MELD) scores, had a higher proportion of recipients with previous history of hypertension, heart disease and hepatic encephalopathy, more intraoperative blood loss and red blood cell transfusion, and had longer intraoperative anhepatic phase time, postoperative ICU length of stay and mechanical ventilation time, and the differences were statistically significant (t= -2. 544 and-2.924, χ² = 9. 815, 6. 506 and 7. 808, Z=-2. 140,-2. 464,-2. 506,-4. 847 and -4. 243,P＜0.05). Within 5 min after total occlusion of the portal vein and inferior vena cava, within 5 min after total opening, and before exit from the operating room at the end of surgery, lactate levels of the MACE group were increased compared with the non-MACE group, and the differences were statistically significant (t=-2.291, -3.322 and -2.392, all P＜0.05). Logistic regression analysis showed that age (OR=1.041, 95%CI 1.008-1.350, P＜0.05), preoperative MELD score (OR=1.057, 95%CI 1.022-1.453, P＜0.05) and history of hypertension (OR=2.149, 95%CI 1.061-4.804, P＜0.05)as well as lactate level within 5 min after total opening of the portal vein and inferior vena cava (OR=1.334, 95%CI 1.088-1.636, P＜0.05) were independent risk factors for MACE during perioperative period of adult liver transplantation. The nomogram constructed according to the results of multivariate regression analysis predicted the perioperative occurrence of MACE in adult liver transplant recipients with an area under curve of 0.736 and a concordance index of 0.8, and internal validation showed a good fit between the predicted incidence and the actual incidence. The overall survival rate at 1 year after surgery was lower in the MACE group than in the non-MACE group (84.2% and 96.1%, P＜0.05).

Conclusions

Age, preoperative MELD score, history of hypertension and lactate level within 5 min after total opening of the portal vein and inferior vena cava were independent risk factors for perioperative MACE in adult liver transplantation. The risk prediction model has a good clinical value in predicting the occurrence of perioperative MACE in adult liver transplantation.

Key words: Liver transplantation, Cardiovascular events, Perioperative period, Model for end-stage liver disease, Hyperlactic acidemia, Nomogram

Shuxian Wang, Lianghao Zhang, Lijun Wang, Hui Zhang, Yuan Guo, Chuanshen Xu, Zhiqiang Li, Jinzhen Cai, Man Xie, We Rao. The establishment of predictive model and influencing factors of major adverse cardiovascular events during perioperative period of adult liver transplantation[J]. Chinese Journal of Transplantation(Electronic Edition), 2024, 18(04): 222-229.

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Figures/Tables 8

组别	例数	性别(例,男/女)	年龄(岁, $\bar{x}$ ±s)	术前BMI(kg/m², $\bar{x}$ ±s)	术前MELD评分(分, $\bar{x}$ ±s)	术前Child Pugh评分[分,M(P₂₅,P₇₅)]	术前左心室射血分数(%, $\bar{x}$ ±s)	术前白蛋白[g/L,M(P₂₅,P₇₅)]	术前凝血酶原时间(s, $\bar{x}$ ±s)
未发生MACE组	488	408/80	52±9	24.2±3.6	11.4±8.3	12(9,13)	63.7±2.9	33.0(29.0,33.0)	16.2±7.0
MACE组	57	44/13	55±10	24.0±3.8	15.3±9.6	8(6,10)	63.2±2.1	32.0(28.5,37.9)	17.2±5.9
t/χ²/Z值	-	1.483	-2.544	0.471	-2.924	-3.771	1.494	-0.788	1.096
P值	-	＞0.05	＜0.05	＞0.05	＜0.05	＞0.05	＞0.05	＞0.05	＞0.05
组别	例数	既往史(例,有/无)					供肝重量(g, $\bar{x}$ ±s)	手术时间(min, $\bar{x}$ ±s)	无肝期时间[min,M(P₂₅,P₇₅)]	供肝冷缺血时间[min,M(P₂₅,P₇₅)]
组别	例数	高血压	糖尿病	心脏病	肝性脑病	上消化道出血	供肝重量(g, $\bar{x}$ ±s)	手术时间(min, $\bar{x}$ ±s)	无肝期时间[min,M(P₂₅,P₇₅)]	供肝冷缺血时间[min,M(P₂₅,P₇₅)]
未发生MACE组	488	46/442	65/423	4/484	56/432	133/355	1 379±300	505±114	55(47,64)	319(270,391)
MACE组	57	13/44	7/50	3/54	14/43	14/43	1 442±367	506±108	61(50,72)	346(280,460)
t/χ²/Z值	-	9.815	0.048	6.506	7.808	0.188	-1.246	-0.033	-2.140	-2.048
P值	-	＜0.05	＞0.05	＜0.05	＜0.05	＞0.05	＞0.05	＞0.05	＜0.05	＞0.05
组别	例数	术中相关指标[M(P₂₅,P₇₅)]				术后ICU住院时间[h,M(P₂₅,P₇₅)]	术后机械通气时间[h,M(P₂₅,P₇₅)]
组别	例数	输注红细胞(U)	液体总入量(mL)	出血量(mL)	尿量(mL)	术后ICU住院时间[h,M(P₂₅,P₇₅)]	术后机械通气时间[h,M(P₂₅,P₇₅)]
未发生MACE组	488	8.0(4.0,12.0)	6 172(5 307,7 492)	1 000(600,2 000)	2 190(1 532,3 008)	91(69,119)	19(15,41)
MACE组	57	10.0(6.0,14.5)	6 285(5 155,7 796)	1 500(800,2 000)	2 000(1 692,3 000)	141(87,190)	39(18,107)
t/χ²/Z值	-	-2.464	-0.405	-2.506	-0.083	-4.847	-4.243
P值	-	＜0.05	＞0.05	＜0.05	＞0.05	＜0.05	＜0.05

组别	例数	性别(例,男/女)	年龄(岁, $\bar{x}$ ±s)	术前BMI(kg/m², $\bar{x}$ ±s)	术前MELD评分(分, $\bar{x}$ ±s)	术前Child Pugh评分[分,M(P₂₅,P₇₅)]	术前左心室射血分数(%, $\bar{x}$ ±s)	术前白蛋白[g/L,M(P₂₅,P₇₅)]	术前凝血酶原时间(s, $\bar{x}$ ±s)
未发生MACE组	488	408/80	52±9	24.2±3.6	11.4±8.3	12(9,13)	63.7±2.9	33.0(29.0,33.0)	16.2±7.0
MACE组	57	44/13	55±10	24.0±3.8	15.3±9.6	8(6,10)	63.2±2.1	32.0(28.5,37.9)	17.2±5.9
t/χ²/Z值	-	1.483	-2.544	0.471	-2.924	-3.771	1.494	-0.788	1.096
P值	-	＞0.05	＜0.05	＞0.05	＜0.05	＞0.05	＞0.05	＞0.05	＞0.05
组别	例数	既往史(例,有/无)					供肝重量(g, $\bar{x}$ ±s)	手术时间(min, $\bar{x}$ ±s)	无肝期时间[min,M(P₂₅,P₇₅)]	供肝冷缺血时间[min,M(P₂₅,P₇₅)]
组别	例数	高血压	糖尿病	心脏病	肝性脑病	上消化道出血	供肝重量(g, $\bar{x}$ ±s)	手术时间(min, $\bar{x}$ ±s)	无肝期时间[min,M(P₂₅,P₇₅)]	供肝冷缺血时间[min,M(P₂₅,P₇₅)]
未发生MACE组	488	46/442	65/423	4/484	56/432	133/355	1 379±300	505±114	55(47,64)	319(270,391)
MACE组	57	13/44	7/50	3/54	14/43	14/43	1 442±367	506±108	61(50,72)	346(280,460)
t/χ²/Z值	-	9.815	0.048	6.506	7.808	0.188	-1.246	-0.033	-2.140	-2.048
P值	-	＜0.05	＞0.05	＜0.05	＜0.05	＞0.05	＞0.05	＞0.05	＜0.05	＞0.05
组别	例数	术中相关指标[M(P₂₅,P₇₅)]				术后ICU住院时间[h,M(P₂₅,P₇₅)]	术后机械通气时间[h,M(P₂₅,P₇₅)]
组别	例数	输注红细胞(U)	液体总入量(mL)	出血量(mL)	尿量(mL)	术后ICU住院时间[h,M(P₂₅,P₇₅)]	术后机械通气时间[h,M(P₂₅,P₇₅)]
未发生MACE组	488	8.0(4.0,12.0)	6 172(5 307,7 492)	1 000(600,2 000)	2 190(1 532,3 008)	91(69,119)	19(15,41)
MACE组	57	10.0(6.0,14.5)	6 285(5 155,7 796)	1 500(800,2 000)	2 000(1 692,3 000)	141(87,190)	39(18,107)
t/χ²/Z值	-	-2.464	-0.405	-2.506	-0.083	-4.847	-4.243
P值	-	＜0.05	＞0.05	＜0.05	＞0.05	＜0.05	＜0.05

组别	例数	入手术室后动脉穿刺成功后即刻
组别	例数	pH值	钠离子浓度(mmol/L)	钾离子浓度(mmol/L)	乳酸(mmol/L)
未发生MACE组	488	7.43±0.05	140.8±4.8	3.56±0.41	1.50±1.18
MACE组	57	7.42±0.05	140.1±5.6	3.54±0.49	1.68±1.14
t值	-	0.526	0.968	0.31	-1.065
P值	-	＞0.05	＞0.05	＞0.05	＞0.05
组别	例数	门静脉和下腔静脉全部阻断后5min内
组别	例数	pH值	钠离子浓度(mmol/L)	钾离子浓度(mmol/L)	乳酸(mmol/L)
未发生MACE组	488	7.39±0.05	145.5±5.3	3.98±0.43	2.97±1.74
MACE组	57	7.39±0.05	143.1±4.5	4.13±0.49	3.53±2.00
t值	-	0.949	1.438	-2.464	-2.291
P值	-	＞0.05	＞0.05	＜0.05	＜0.05
组别	例数	门静脉和下腔静脉全部开放后5min内
组别	例数	pH值	钠离子浓度(mmol/L)	钾离子浓度(mmol/L)	乳酸(mmol/L)
未发生MACE组	488	7.35±0.06	145.5±4.9	3.85±0.81	4.92±2.18
MACE组	57	7.34±0.09	145.8±5.5	3.83±0.91	6.60±3.74
t值	-	0.634	-0.462	0.141	-3.322
P值	-	＞0.05	＞0.05	＞0.05	＜0.05
组别	例数	出手术室前
组别	例数	pH值	钠离子浓度(mmol/L)	钾离子浓度(mmol/L)	乳酸(mmol/L)
未发生MACE组	488	7.39±0.06	146.0±4.6	3.71±0.40	4.57±2.82
MACE组	57	7.38±0.06	146.6±6.0	3.77±0.48	6.00±4.40
t值	-	0.753	-0.732	-1.047	-2.392
P值	-	＞0.05	＞0.05	＞0.05	＜0.05

参数	β值	标准误	Waldχ²值	P值	OR值	95%CI
年龄(岁)	0.042	0.016	6.649	＜0.05	1.041	1.008～1.350
术前MELD评分(分)	0.049	0.016	9.621	＜0.05	1.057	1.022～1.453
高血压病史	1.039	0.386	7.249	＜0.05	2.149	1.061～4.804
门静脉和下腔静脉全部开放后5min内乳酸水平(mmol/L)	0.212	0.051	17.082	＜0.05	1.334	1.088～1.636

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