术前炎症指标预测肝移植术后感染的价值

The prediction effect of preoperative inflammatory indicators in infection after liver transplantation

目的探讨术前炎症指标预测肝移植术后感染的价值,分析肝移植术后感染的相关危险因素。方法2016年1月~2022年2月收治的原位肝移植病人90例,根据术后是否并发感染分为感染组(20例)和非感染组(70例),对可能导致术后感染的相关因素进行单因素分析,然后将有显著性差异的因素纳入二元Logistic回归分析。结果单因素分析结果显示,受者术前中性粒细胞与淋巴细胞比值(NLR)、术前血清总胆红素、术中失血量、术前终末期肝病模型(MELD)评分≥18分、术前合并糖尿病及术后出现胆道并发症是术后发生感染的因素(P<0.05);Logistic回归分析显示,NLR升高及术前合并糖尿病是术后发生感染的危险因素。ROC曲线分析显示,NLR=3.07时具有较好的灵敏度和特异度,ROC曲线下面积为0.702。结论NLR在肝移植术后发生感染的病人中异常升高,通过检测上述指标可评估病人术后感染风险。术前合并糖尿病是术后发生感染的独立危险因素。

Objective To explore the predictive effect of preoperative blood inflammation indicators in postoperative infection,and to analyze the related risk factors for infection after liver transplantation.Methods The clinical data of 90 orthotopic liver transplantation patientsin People’s Hospital of Wuhan University from January 2016 to February 2022 were retrospectively analyzed and divided into infection group(n=20)and non-infection group(n=70).Univariate analysis was performed on perioperative related factors that may lead to infection,and then factors with significant differences were included in Logistic regression multivariate analysis.Results Univariate analysis showed that preoperative neutrophil to lymphocyte ratio(NLR),preoperative total bilirubin,intraoperative blood loss,MELD score≥18,preoperative diabetes and postoperative biliary complications were single factors of postoperative infection(P<0.05);Multivariate Logistic regression analysis showed that elevated NLR and preoperative diabetes were risk factors for postoperative infection.The ROC curve analysis showed good sensitivity and specificity at NLR=3.07,with an area under the ROC curve of 0.702.Conclusion NLR levels are abnormally elevated in patients with infection after liver transplantation,and the risk of postoperative infection can be assessed by testing the above index levels.In addition,preoperative diabetes mellitus is independent risk factors for postoperative infection,and more attention should be paid to such patients.