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《天津医科大学学报》[ISSN:1006-8147/CN:12-1259/R]

卷:

29卷

期数:

2023年02期

页码:

178-182

栏目:

临床医学

出版日期:

2023-03-20

文章信息/Info

Title:

Evaluation of the modified Charlson comorbidity index for predicting early complications after liver transplantation in elderly patients

文章编号:

1006-8147（2023）02-0178-05

作者:

高犇¹; 代星¹; 李江²

1.天津医科大学一中心临床学院普通外科，天津 300192;2.天津市第一中心医院器官移植科，天津 300192

Author(s):

GAO Ben¹; DAI Xing¹; LI Jiang²

1.Department of General Surgery,The First Central Clinical College，Tianjin Medical University，Tianjin 300192，China;2.Department of Organ Transplantation，Tianjin First Central Hospital，Tianjin 300192，China

关键词:

查尔森合并症指数; 老年人; 肝移植; 并发症

Keywords:

Charlson comorbidity index; elderly; liver transplantation; complications

分类号:

R617

DOI:

-

文献标志码:

A

摘要:

目的：探讨改良查尔森合并症指数（CCI）对老年原位肝移植（OLT）患者术后发生严重并发症的评估价值。方法：回顾性分析2014年1月—2018年12月于天津市第一中心医院实施肝移植治疗的84例65岁以上患者资料，其中男64例，女20例。结合住院病历资料对患者合并症进行量化，计算出每个患者OLT-CCI总评分。通过Clavien-Dindo并发症分级系统，≥Ⅲ级定义为重度并发症，将患者分为轻度并发症组（60例）和重度并发症组（24例）。分别比较两组性别、年龄、原发病良恶性、有无中度贫血、肝脏手术和上消化道出血史、老年营养风险指数（GNRI）、终末期肝病模型（MELD）评分、OLT-CCI、冷缺血时间、热缺血时间、手术时间、术中失血量和术后住院时间的差异，对差异有统计学意义的变量进一步行多因素Logistic回归分析。结果：轻、重度并发症组OLT-CCI（Z=-2.093，P=0.036）、GNRI（t=3.633，P＜0.001）、术后住院时间（Z=-2.065，P=0.039）、中度贫血（χ2=12.124，P=0.001）和既往肝脏手术史（χ2=12.124，P=0.001）的差异均具有统计学意义；多因素Logistic回归分析显示，OLT-CCI（OR=1.804，95%CI：1.028～3.168，P=0.040）、GNRI（OR=0.919，95%CI：0.866～0.976，P=0.006）、术后住院时间（OR=1.027，95%CI：1.003～1.052，P=0.030）和既往肝脏手术史（OR=8.183，95%CI：1.568～42.694，P=0.013）是老年患者肝移植术后发生重度并发症的独立危险因素，建立模型预测受试者工作特征（ROC）曲线下面积（AUC）为0.892。结论：OLT-CCI联合GNRI、术后住院时间、既往肝脏手术史对老年患者肝移植术后重度并发症的发生具有一定的预测价值。

Abstract:

Objective：To investigate the value of modified Charlson comorbidity index（CCI）in evaluating postoperative complications in elderly orthotopic liver transplantation （OLT）recipients. Methods: The data of 84 elderly patients who underwent liver transplantation in Tianjin First Central Hospital from January 2014 to December 2018 were retrospectively analyzed，including 64 males and 20 females. The total OLT-CCI score of each patient was calculated by quantifying the comorbidities combined with the medical records of inpatients. According to Clavien-Dindo Complication Grading System，≥Ⅲgrade was defined as severe complication，and patients were divided into mild complication group（n=60）and severe complication group（n=24）. The differences of gender，age，benign and malignant primary diseases，moderate anemia，liver surgery and upper gastrointestinal bleeding history，geriatric nutritional risk index（GNRI），MELD score， OLT-CCI，cold and warm ischemia time，operation time，intraoperative blood loss and length of postoperative hospital stay were compared between the two groups. Variables with statistically significant differences were included in multivariate Logistic regression analysis. Results:There were significant differences in OLT-CCI（Z=-2.093，P=0.036），GNRI（t=3.633，P＜0.001），postoperative hospital stay（Z=-2.065，P=0.039），moderate anemia（χ2=12.124，P=0.001），and previous liver surgery（χ2=12.124，P=0.001）between the mild and severe complication groups; Multivariate Logistic regression analysis showed that OLT-CCI（OR=1.804，95%CI :1.028-3.168，P=0.040）， GNRI（OR=0.919，95%CI：0.866-0.976，P=0.006），postoperative hospital stay（OR=1.027，95%CI:1.003-1.052，P=0.030）and history of previous liver surgery（OR=8.183，95%CI：1.568-42.694，P=0.013）were independent risk factors for severe complications after liver transplantation in elderly patients. The area under the ROC curve（AUC）of the established model was 0.892. Conclusion：OLT-CCI combined with GNRI，postoperative hospital stay，and previous liver surgery history have certain predictive value for the occurrence of severe complications after liver transplantation in elderly patients.

参考文献/References:

[1] TAJIRI K，SHIMIZU Y. Liver physiology and liver diseases in the el－derly[J]. World J Gastroenterol，2013，19（46）：8459-8467.
[2] DOLNIKOV S，ADAM R，CHERQUI D，et al. Liver transplantation in elderly patients：what do we know at the beginning of 2020?[J]. Surg Today，2020，50（6）：533-539.
[3] ADAM R，KARAM V，DELVART V，et al. Evolution of indications and results of liver transplantation in Europe. A report from the Eu－ropean Liver Transplant Registry（ELTR）[J]. J Hepatol，2012，57（3）：675-688.
[4] CHARLSON M E，POMPEI P，ALES K L，et al. A new method of classifying prognostic comorbidity in longitudinal studies：develop－ment and validation[J]. J Chronic Dis，1987，40（5）：373-383.
[5] CHARLSON M，SZATROWSKI T P，PETERSON J，et al. Validation of a combined comorbidity index[J]. J Clin Epidemiol，1994，47（11）：1245-1251.
[6] SHUVY M，ZWAS D R，KEREN A，et al. The age-adjusted Charlson comorbidity index：a significant predictor of clinical outcome in pa－tients with heart failure[J]. Eur J Intern Med，2020，73：103-104.
[7] KANG H W，KIM S M，KIM W T，et al. The age-adjusted Charlson comorbidity index as a predictor of overall survival of surgically treated non-metastatic clear cell renal cell carcinoma[J]. J Cancer Res Clin Oncol，2020，146（1）：187-196.
[8] KOSEKI Y，HIKAGE M，FUJIYA K，et al. Utility of a modified age-adjusted Charlson comorbidity index in predicting cause-specific survival among patients with gastric cancer [J]. Eur J Surg Oncol， 2021，47（8）：2010-2015.
[9] ST-LOUIS E，IQBAL S，FELDMAN L S，et al. Using the age-ad－justed Charlson comorbidity index to predict outcomes in emergency general surgery[J]. J Trauma Acute Care Surg，2015，78（2）：318-323.
[10] JASSAL S V，SCHAUBEL D E，FENTON SSA. Baseline comorbidity in kidney transplant recipients：a comparison of comorbidity indices [J]. Am J Kidney Dis，2005，46（1）：136-142.
[11] VOLK M L，HERNANDEZ J C，LOK A S，et al. Modified Charlson comorbidity index for predicting survival after liver transplanta－tion[J]. Liver Transpl，2007，13（11）：1515-1520.
[12] PETROWSKY H，RANA A，KALDAS F M，et al. Liver transplanta－tion in highest acuity recipients：identifying factors to avoid futil－ity[J]. Ann Surg，2014，259（6）：1186-1194.
[13] ALIM A，MALAMUTMANN E，DAYANGAC M，et al. Comorbidity index as a selection tool for living donor liver transplantation in el－derly patients[J]. Transplant Proc，2019，51（10）：3315-3319.
[14] NIEWIN′SKI G，GRACZYN′SKA A，MORAWIEC S，et al. Renais－sance of modified Charlson comorbidity index in prediction of short-and long-term survival after liver transplantation[J]. Med Sci Monit， 2019，25：4521-4526.
[15] DINDO D，DEMARTINES N，CLAVIEN P-A. Classification of sur－gical complications：a new proposal with evaluation in a cohort of 6336 patients and results of a survey[J]. Ann Surg，2004，240（2）：205-213.
[16] 周玉洁，吕启圆，李现文.共病及共病指数研究进展与应用 展望[J].中国公共卫生，2015，31（11）：1513-1516.
[17] 蒋红莲，闫伟，路云.老年共病指数的应用 与推广问题研究[J].中国慢性病预防与控制，2020，28（7）：548-551.
[18] WASILEWICZ M，RASZEJA-WYSZOMIRSKA J，WUNSCH E，et al. Modified Charlson comorbidity index in predicting early mortality af－ter liver transplantation[J]. Transplant Pro，2009，41（8）：3117-3118.
[19] KWON J H，YOON Y I，SONG G W，et al. Living donor liver trans－plantation for patients older than age 70 years：a single-center expe－rience[J]. Am J Transplant，2017，17（11）：2890-2900.
[20] KOLLMANN D，MASCHKE S，RASOUL-ROCKENSCHAUB S，et al. Outcome after liver transplantation in elderly recipients（65 years）-asingle-center retrospective analysis[J]. Dig Liver Dis，2018， 50（10）：1049-1055.
[21] G譫MEZ GAVARA C，ESPOSITO F，GURUSAMY K，et al. Liver transplantation in elderly patients：a systematic review and first meta-analysis[J]. HPB（Oxford），2019，21（1）：14-25.
[22] AKDUR A，FIDAN C，AYVAZOGLU SOY E，et al. Results of liver transplant in elderly patients：a single center experience[J]. Exp Clin Transplant，2015，13（Suppl 1）：124-126.
[23]沈中阳，朱志军，郑卫萍，等.老年患者的肝移植[J].中华器官移植杂志，2007，28（2）：101-104.
[24]范小玲，刘景院，沈中阳.终末期肝病合 并糖尿病与肝移植的临床研究[J].中华医学研究杂志，2003，3（7）：593-594.
[25] WANG YJ，LI JH，GUAN Y，et al. Diabetes mellitus is a risk factor of acute kidney injury in liver transplantation patients[J]. Hepatobiliary Pancreat Dis Int，2021，20（3）：215-221.
[26] BOUILLANNE O，MORINEAU G，DUPONT C，et al. Geriatric nutri－tional risk index：a new index for evaluating at-risk elderly medical patients[J]. Am J Clin Nutr，2005，82（4）：777-783.
[27] MALAMUTMANN E，FRENZEN A，KARADAG H I，et al. Inner ab－dominal fat and psoas muscle as predictive factors for the outcome after liver transplant[J]. Exp Clin Transplant，2021，19（2）：131-136.

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备注/Memo

备注/Memo:

作者简介：高犇（1997-），男，硕士在读，研究方向：肝移植；
通信作者：李江，E-mai：lijiang_009@163.com。

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更新日期/Last Update: 2023-04-30