肝移植术中输血的危险因素分析

Analysis of risk factors of intraoperative blood transfusion during liver transplantation

目的探讨肝移植患者术中输血的危险因素并建立术中输血的预测模型。方法回顾性收集首都医科大学附属北京佑安医院2020年3月至2020年12月期间符合本研究纳入和排除标准的肝移植手术患者,采用单因素和logistic多因素回归分析评估肝移植患者术中输血的危险因素及构建术中输血的预测模型。结果本研究共收集到符合研究条件的肝移植患者151例,其中未输血患者51例、输血患者100例,单因素分析发现,二者在初级诊断及术前的血红蛋白(hemoglobin,Hb)、血小板计数、凝血酶原时间、国际标准化比值、ChildTurcotte-Pugh评分和终末期肝病模型(model for end-stage liver disease,MELD)评分方面比较差异有统计学意义(P<0.05),将这些单因素分析所筛选出来的变量通过逐步法进行变量筛选,最终筛选出术前Hb和MELD评分这2个变量进入多因素logistic回归分析,结果显示,术前Hb≤113 g/L及MELD>14分增加肝移植术中输血的概率[Hb:OR=6.652,95%CI(2.282,19.392),P<0.001;MELD评分:OR=16.037,95%CI(6.336,40.592),P<0.001],以此构建的logistic回归模型预测术中输血的受试者操作特征曲线下面积为0.873[95%CI(0.808,0.919),P<0.001],其灵敏度为91.0%,特异度为67.5%,约登指数为0.674,准确性为86.1%。结论从本研究结果提示,肝移植患者术前Hb≤113 g/L及MELD评分>14分增加肝移植术中输血发生几率,以此构建的logistic回归模型预测术中输血的灵敏度和特异度较高。

Objective To explore risk factors of blood transfusion during liver transplantation and construct its prediction model.Methods The patients underwent liver transplantation who met the inclusion and exclusion criteria of this study from March 2020 to December 2020 in the Beijing Youan Hospital of Capital Medical University were retrospectively collected.The univariate and logistic multivariate analysis were used to evaluate the risk factors of blood transfusion during liver transplantation and construct the prediction model for intraoperative blood transfusion.Results A total of 151 eligible liver transplantation patients were collected in this study,including 51 non-transfusion patients and 100 transfusion patients.The univariate analysis results showed that the differences of primary diagnosis,preoperative hemoglobin(Hb),platelet count,prothrombin time,international normalized ratio,Child-Turcotte-Pugh score,and end-stage liver disease(MELD)score were statistically different between them(P<0.05).The above variables selected by the univariate analysis were selected by stepwise method,then the preoperative Hb and MELD score were selected into the multivariate logistic regression analysis,the results showed that the preoperative Hb≤113 g/L and MELD score>14 increased the risk of blood transfusion during liver transplantation[Hb:OR=6.652,95%CI(2.282,19.392),P<0.001;MELD score:OR=16.037,95%CI(6.336,40.592),P<0.001].The logistic regression model predicted the area under receiver operating characteristic curve was 0.873[95%CI(0.808,0.919),P<0.001],the sensitivity and specificity were91.0%and 67.5%,respectively,Youden index was 0.674,the accuracy was 86.1%.Conclusions Results of this study suggest that preoperative Hb≤113 g/L and MELD score>14 increase risk of blood transfusion during liver transplantation.Logistic regression model constructed according to preoperative Hb and MELD score has a better sensitivity and specificity of intraoperative blood transfusion.