肝移植患者术前红细胞分布宽度与术后死亡和并发症关系的回顾性观察研究

Associations of preoperative red cell distribution width with mortality and morbidity in patients underwent liver transplantation:a retrospectively observational study

目的分析同种异体肝移植手术患者术前红细胞分布宽度(red cell distribution width,RDW)与术后死亡和并发症的关系。方法回顾性收集2017年6月至2020年5月期间于四川大学华西医院行同种异体肝移植手术患者的临床病理资料,根据RDW正常临界值(14.5%)将患者分为RDW≤14.5%组和RDW>14.5%组,应用倾向性评分匹配校正二者的基线资料,然后比较二者的术后1年病死率、1年生存情况、30 d病死率、早期移植物功能不全发生率、急性肾损伤发生率、肾脏替代治疗率、肺部并发症发生率、重症监护病房停留时间、住院时间。结果共纳入符合分析条件的患者303例,其中RDW≤14.5%组77例、RDW>14.5%组226例,2组各有57例匹配成功。匹配后2组患者的基线资料如受体性别、年龄、体质量指数、原发疾病、MELD评分、Child-Pugh分级以及供体性别、年龄、体质量指数比较差异均无统计学意义(P>0.05)。RDW>14.5%组患者术后1年病死率[22.8%(13/57)比5.3%(3/57),χ^(2)=7.27,P=0.007]和30 d病死率[15.8%(9/57)比3.5%(2/57),χ^(2)=4.93,P=0.026]均高于RDW≤14.5%组。生存分析结果表明,RDW≤14.5%组患者肝移植术后1年生存情况优于RDW>14.5%组[风险比为4.75,95%CI为(1.78,12.67),P=0.007],但2组患者的早期移植物功能不全发生率、急性肾损伤发生率、肾脏替代治疗率、肺部并发症发生率以及术后住院时间和重症监护病房停留时间比较差异均无统计学意义(P>0.05)。结论本研究结果初步显示了同种异体肝移植手术患者术前RDW与术后1年病死率、30 d病死率及1年生存情况有一定的关系。

Objective To investigate the associations of preoperative red cell distribution width(RDW)with mortality and morbidity in patients underwent liver transplantation.Methods This investigation was a retrospective study,the patients underwent liver transplantation met the inclusion criteria from June 2017 to May 2020 in the West China Hospital of Sichuan University were enrolled.The patients were divided into RDW≤14.5%group and RDW>14.5%group according to the normal RDW critical value(14.5%).The propensity score matching(PSM)was used to adjust the baseline characteristics.The primary outcome was 1-year mortality.The secondary outcomes included 1-year survival,30-day mortality,incidence of early allograft dysfunction,acute kidney injury,renal replacement therapy,and pulmonary complications,as well as ICU stay and postoperative hospital stay.Results A total of 303 patients who met the analysis conditions were included.After PSM,57 patients in each group were matched.There were no significant differences between the two groups in the baseline data such as the gender,age,body mass index(BMI),initial diagnosis,MELD score,Child-Pugh grade of the recipients,and the gender,age,and BMI of the donors(P>0.05).The 1-year[22.8%(13/57)versus 5.3%(3/57),χ^(2)=7.27,P=0.007]and 30-day[15.8%(9/57)versus 3.5%(2/57),χ^(2)=4.93,P=0.026]mortality of the patients with RDW>14.5%were higher than that of the patients with RDW≤14.5%.The Kaplan-Meier survival curve showed that the 1-year survival of the patients with RDW≤14.5%after liver transplantation was better than that of the patients with RDW>14.5%[hazard ratio=4.75,95%CI(1.78,12.67),P=0.007],but there were no significant differences between the two groups in the incidence of early graft dysfunction,acute renal injury,renal replacement therapy,and pulmonary complications,as well as postoperative hospital stay and ICU stay(P>0.05).Conclusion Preliminary results of this study indicate that preoperative RDW of patients underwent allogeneic liver transplantation is associated with 1-year mortality,30-day mortality,and 1-year survival.