肝移植术中大量输血的影响因素分析及预测模型构建

目的探讨肝脏移植术中大量输血的影响因素,并建立大量输血的预测模型。方法回顾性分析南京大学医学院附属鼓楼医院2018年度肝脏外科同一肝移植小组进行的103例肝移植受者资料,根据受者术中红细胞输注量分为大量输血组(≥12 U)40例和非大量输血组(<12 U)63例,比较分析两组受者的一般情况和术前指标,用Logistic回归分析法得出肝移植术中大量输血的预测模型。结果大量输血组和非大量输血组在性别、年龄、血型等方面差异无统计学意义(P>0.05),而术前诊断、血红蛋白(Hb)、血细胞比容(HCT)、血小板计数(PLT)、国际标准化比值(INR)、凝血酶原时间(PT)、部分活化凝血活酶时间(APTT)、凝血酶时间(TT)、血清总胆红素(TBIL)、血清直接胆红素(DBIL)、终末期肝病模型(MELD)评分等指标与术中大量输血存在相关性(P<0.05)。通过Logistic回归分析,得出肝移植术中大量输血的预测模型为Y=3.545-0.112×HCT-0.009×PLT+0.005×DBIL。其预测值经受试者操作特征曲线曲线分析得出曲线下面积为0.813,灵敏度和特异度分别为80.0%和71.4%,约登指数(Youden's index)为0.514,即Y≥0.514时则可能发生术中大量输血。结论肝移植受者术前HCT、PLT和DBIL可以作为术中大量输血的独立预测因素,其预测模型有较好的灵敏度和特异度。

Analysis of influencing factors of massive blood transfusion during liver transplantation and constructing a predictive model

Objective To explore the influencing factors of massive blood transfusion during liver transplantation and establish a prediction model for massive blood transfusion.Methods Clinical data were analyzed retrospectively for 103 patients undergoing liver transplantation performed by the same surgical team of our hospital in 2018 from Department of Blood Transfusion Affiliated Drum Tower Hospital Nanjing University Medical School.According to the intraoperative volume of red blood cells,they were divided into two groups of massive transfusion(≥12U,n=40)and non-massive transfusion(<12U,n=63).General patient data and preoperative laboratory parameters were compared between two groups.Logistic regression analysis was utilized for constructing a prediction model for massive transfusion during liver transplantation.Results No significant inter-group difference existed in gender,age or blood group(P>0.05)while preoperative diagnosis,hemoglobin(Hb),hematocrit(HCT),platelet count(PLT),international normalized ratio(INR),prothrombin time(PT),activated partial thromboplastin time(APTT),thrombin time(TT),total bilirubin(TBIL),direct bilirubin(DBIL)and end-stage liver disease(MELD)score were correlated with intraoperative massive blood transfusion(P<0.05).By Logistic regression analysis,the predictive model of massive blood transfusion in liver transplantation was Y=3.545-0.112×HCT-0.009×P LT+0.005×DBIL.The area under ROC curve was 0.813 and the sensitivity and specificity 80.0%and 71.4%respectively.Youden's index of 0.514 indicated that if Y value was greater than or equal to 0.514,massive blood transfusion might occur.Conclusions Preoperative HCT,PLT and DBIL may be employed as independent predictors of intraoperative massive transfusion during liver transplantation.The prognostic model has demonstrated an excellent sensitivity and specificity.