Physiology and health assessment,risk balance,and model for endstage liver disease scores:Postoperative outcome of liver transplantation  

作　　者：Raquel Hohenreuther Andresa ThoméSilveira Edison Moraes Rodrigues Filho Anderson Garcez Bruna Goularth Lacerda Sabrina Alves Fernandes Claudio Augusto Marroni 

机构地区：[1]Postgraduate Program in Hepatology,Universidade Federal de Ciências da Saúde de Porto Alegre,Porto Alegre 90050-170,Brazil [2]Department of Intensive Medicine,Hospital de Clínicas de Porto Alegre,Porto Alegre 90035-903,Brazil [3]Department of Public Health,University of Vale do Rio dos Sinos,Sao Leopoldo 93022-750,Brazil

出　　处：《World Journal of Transplantation》2025年第1期86-94,共9页世界移植杂志（英文）

摘　　要：BACKGROUND Liver transplantation aims to increase the survival of patients with end-stage liver diseases and improve their quality of life.The number of organs available for transplantation is lower than the demand.To provide fair organ distribution,predictive mortality scores have been developed.AIM To compare the Acute Physiology and Chronic Health Evaluation IV(APACHE IV),balance of risk(BAR),and model for end-stage liver disease(MELD)scores as predictors of mortality.METHODS Retrospective cohort study,which included 283 adult patients in the postoperative period of deceased donor liver transplantation from 2014 to 2018.RESULTS The transplant recipients were mainly male,with a mean age of 58.1 years.Donors were mostly male,with a mean age of 41.6 years.The median cold ischemia time was 3.1 hours,and the median intensive care unit stay was 5 days.For APACHE IV,a mean of 59.6 was found,BAR 10.7,and MELD 24.2.The 28-day mortality rate was 9.5%,and at 90 days,it was 3.5%.The 28-day mortality prediction for APACHE IV was very good[area under the curve(AUC):0.85,P<0.001,95%CI:0.76-0.94],P<0.001,BAR(AUC:0.70,P<0.001,95%CI:0.58–0.81),and MELD(AUC:0.66,P<0.006,95%CI:0.55-0.78),P<0.008.At 90 days,the data for APACHE IV were very good(AUC:0.80,P<0.001,95%CI:0.71–0.90)and moderate for BAR and MELD,respectively,(AUC:0.66,P<0.004,95%CI:0.55–0.77),(AUC:0.62,P<0.026,95%CI:0.51–0.72).All showed good discrimination between deaths and survivors.As for the best value for liver transplantation,it was significant only for APACHE IV(P<0.001).CONCLUSION The APACHE IV assessment score was more accurate than BAR and MELD in predicting mortality in deceased donor liver transplant recipients.

关 键 词：Liver transplantation Acute physiology and chronic health evaluation IV Balance of risk Model for end-stage liver disease MORTALITY Intensive care unit 

分 类 号：R726.5[医药卫生—儿科]