Factors influencing pulmonary complications after liver transplantation and the construction of a predictive model_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

XU Lei ^1,2 , ZHANG Yanlin ¹ , CAO Lin ¹ , ZHOU Bin ¹ ,  ZHANG Tao ^1,2

1. Department of Anesthesiology, General Hospital of Eastern Theater Command, Nanjing 210001, P. R. China;
2. Department of Anesthesiology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing 210001, P. R. China;

Corresponding author：

ZHANG Tao, Email: zhangtao765567@126.com

Keywords：

postoperative pulmonary complication; liver transplantation; Nomogram; prediction model

DOI：

10.7507/1007-9424.202212058

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To investigate the factors influencing the occurrence of postoperative pulmonary complications (PPCs) in liver transplant recipients and to construct Nomogram model to identify high-risk patients. Methods The clinical data of 189 recipients who underwent liver transplantation at the General Hospital of Eastern Theater Command from November 1, 2019 to November 1, 2022 were retrospective collected, and divided into PPCs group (n=61) and non-PPCs group (n=128) based on the occurrence of PPCs. Univariate and multivariate logistic regression analyses were used to determine the risk factors for PPCs, and the predictive effect of the Nomogram model was evaluated by receiver operator characteristic curve (ROC) and calibration curve. Results Sixty-one of 189 liver transplant patients developed PPCs, with an incidence of 32.28%. Univariate analysis results showed that PPCs were significantly associated with age, smoking, Child-Pugh score, combined chronic obstructive pulmonary disease (COPD), combined diabetes mellitus, prognostic nutritional index (PNI), time to surgery, amount of bleeding during surgery, and whether or not to diuretic intraoperatively (P<0.05). Multivariate logistic regression analysis showed that age [OR=1.092, 95%CI (1.034, 1.153), P=0.002], Child-Pugh score [OR=1.575, 95%CI (1.215, 2.041), P=0.001], combined COPD [OR=4.578, 95%CI (1.832, 11.442), P=0.001], combined diabetes mellitus [OR=2.548, 95%CI (1.024, 6.342), P=0.044], preoperative platelet count (PLT) [OR=1.076, 95%CI (1.017, 1.138), P=0.011], and operative time [OR=1.061, 95%CI (1.012, 1.113), P=0.014] were independent risk factors for PPCs. The prediction model for PPCs which constructed by using the above six independent risk factors in Nomogram had an area under the ROC curve of 0.806. Hosmer and Lemeshow goodness of fit test (P=0.129), calibration curve, and decision curve analysis showed good agreement with Nomogram model. Conclusion The Nomogram model constructed based on age, Child-Pugh score, combined COPD, combined diabetes mellitus, preoperative PLT, and time of surgery can better identify patients at high risk of developing PPCs after liver transplantation.

Citation： XU Lei, ZHANG Yanlin, CAO Lin, ZHOU Bin, ZHANG Tao. Factors influencing pulmonary complications after liver transplantation and the construction of a predictive model. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2023, 30(5): 575-581. doi: 10.7507/1007-9424.202212058 Copy

1.	Miskovic A, Lumb AB. Postoperative pulmonary complications. Br J Anaesth, 2017, 118(3): 317-334.
2.	Jammer I, Wickboldt N, Sander M, et al. Standards for definitions and use of outcome measures for clinical effectiveness research in perioperative medicine: European Perioperative Clinical Outcome (EPCO) definitions: a statement from the ESA-ESICM joint taskforce on perioperative outcome measures. Eur J Anaesthesiol, 2015, 32(2): 88-105.
3.	张四梅, 安睿, 刘琳, 等. 围手术期液体治疗对经典原位肝移植术后早期肺部并发症的影响. 中华外科杂志, 2019, 57(6): 440-446.
4.	Dou XJ, Wang QP, Liu WH, et al. Effect of cardiac output-guided hemodynamic management on acute lung injury in pediatric living donor liver transplantation. World J Gastrointest Surg, 2022, 14(9): 1037-1048.
5.	Wang H, Xing R, Li X, et al. Risk factors for pulmonary complications after laparoscopic liver resection: a multicenter retrospective analysis. Surg Endosc, 2023, 37(1): 510-517.
6.	Shoka M, Kanda M, Ito S, et al. Systemic inflammation score as a predictor of pneumonia after radical resection of gastric cancer: analysis of a multi-institutional dataset. Dig Surg, 2020, 37(5): 401-410.
7.	Smith CJ, Bray BD, Hoffman A, et al. Can a novel clinical risk score improve pneumonia prediction in acute stroke care? A UK multicenter cohort study. J Am Heart Assoc, 2015, 4(1): e001307. doi: 10.1161/JAHA.114.001307.
8.	庄红霞, 荆晓雷, 王雪琪, 等. 帕金森病患者脑深部电刺激术后肺部并发症列线图预测模型的构建及其预测价值. 中华神经医学杂志, 2021, 20(3): 233-239.
9.	Kostakis ID, Sotiropoulos GC, Kouraklis G. Pneumocystis jirovecii pneumonia in liver transplant recipients: a systematic review. Transplant Proc, 2014, 46(9): 3206-3208.
10.	Pedersen MR, Choi M, Brink JA, et al. Pretransplant factors and associations with postoperative respiratory failure, ICU length of stay, and short-term survival after liver transplantation in a high MELD population. J Transplant, 2016, 2016: 6787854. doi: 10.1155/2016/6787854.
11.	Cardoso FS, Karvellas CJ. Respiratory complications before and after liver transplant. J Intensive Care Med, 2019, 34(5): 355-363.
12.	Chen C, Yang D, Gao S, et al. Development and performance assessment of novel machine learning models to predict pneumonia after liver transplantation. Respir Res, 2021, 22(1): 94. doi: 10.1186/s12931-021-01690-3.
13.	罗文婷, 曹丽, 吕德珍, 等. 基于PNI、SII、CAR的列线图模型对肝移植术后腹腔感染的预测价值. 器官移植, 2022, 13(4): 503-508.
14.	Li X, Chen C, Wei X, et al. Retrospective comparative study on postoperative pulmonary complications after orthotopic liver transplantation using the Melbourne Group Scale (MGS-2) diagnostic criteria. Ann Transplant, 2018, 23: 377-386.
15.	Chen D, Ding Y, Zhu W, et al. Frailty is an independent risk factor for postoperative pulmonary complications in elderly patients undergoing video-assisted thoracoscopic pulmonary resections. Aging Clin Exp Res, 2022, 34(4): 819-826.
16.	Li X, Wei X, Chen C, et al. N-acetylcysteine inhalation improves pulmonary function in patients received liver transplantation. Biosci Rep, 2018, 38(5): BSR20180858. doi: 10.1042/BSR20180858.
17.	Magalhães CBA, Nogueira IC, Marinho LS, et al. Exercise capacity impairment can predict postoperative pulmonary complications after liver transplantation. Respiration, 2017, 94(3): 272-278.
18.	刘新阳, 张慧, 郑智滢, 等. 313例原位肝移植受者术后早期肺部并发症危险因素分析. 中华器官移植杂志, 2022, 43(3): 141-145.
19.	Xiaowei M, Wei Z, Qiang W, et al. Assessment of systemic immune-inflammation index in predicting postoperative pulmonary complications in patients undergoing lung cancer resection. Surgery, 2022, 172(1): 365-370.
20.	Tong C, Liu Y, Wu J. Development and validation of a novel nomogram for postoperative pulmonary complications following minimally invasive esophageal cancer surgery. Updates Surg, 2022, 74(4): 1375-1382.
21.	Dai Y, Sun G, Hu H, et al. Risk factors for postoperative pulmonary complications in elderly patients receiving elective colorectal surgery: A retrospective study. Front Oncol, 2022, 12: 1002025. doi: 10.3389/fonc.2022.1002025. eCollection 2022.
22.	Xue Q, Wen D, Ji MH, et al. Developing machine learning algorithms to predict pulmonary complications after emergency gastrointestinal surgery. Front Med (Lausanne), 2021, 8: 655686. doi: 10.3389/fmed.2021.655686.
23.	Baar W, Semmelmann A, Knoerlein J, et al. Risk factors for postoperative pulmonary complications leading to increased in-hospital mortality in patients undergoing thoracotomy for primary lung cancer resection: A multicentre retrospective cohort study of the german thorax registry. J Clin Med, 2022, 11(19): 5774. doi: 10.3390/jcm11195774.
24.	Fan Chiang YH, Lee YW, Lam F, et al. Smoking increases the risk of postoperative wound complications: a propensity score-matched cohort study. Int Wound J, 2023, 20(2): 391-402.
25.	Lumb AB. Pre-operative respiratory optimisation: an expert review. Anaesthesia, 2019, 74 Suppl 1: 43-48.
26.	Wang B, Chen Z, Zhao R, et al. Development and validation of a nomogram to predict postoperative pulmonary complications following thoracoscopic surgery. PeerJ, 2021, 9: e12366. doi: 10.7717/peerj.12366.
27.	左静, 刘喻萍, 金奇彦, 等. 2型糖尿病患者术前血糖水平与肺切除术后肺部并发症之间的关系. 中国胸心血管外科临床杂志: 1-8[2023-03-28]. http://kns.cnki.net/kcms/detail/51.1492.R.20220223.1111.002.html.
28.	Cavayas YA, Eljaiek R, Rodrigue É, et al. Preoperative diaphragm function is associated with postoperative pulmonary complications after cardiac surgery. Crit Care Med, 2019, 47(12): e966-e974. doi: 10.1097/CCM.0000000000004027.
29.	Wang Y, Hu X, Su MC, et al. Postoperative elevations of neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios predict postoperative pulmonary complications in non-small cell lung cancer patients: a retrospective cohort study. Curr Med Sci, 2020, 40(2): 339-347.
30.	张四梅, 安睿, 刘琳, 等. 围手术期液体治疗对经典原位肝移植术后早期肺部并发症的影响. 中华外科杂志, 2019, 57(6): 440-446.
31.	Chandler D, Mosieri C, Kallurkar A, et al. Perioperative strategies for the reduction of postoperative pulmonary complications. Best Pract Res Clin Anaesthesiol, 2020, 34(2): 153-166.
32.	胡嫒, 陈唯韫, 黄宇光. 输血相关急性肺损伤发病机制及防治措施研究进展. 中国医学科学院学报, 2020, 42(5): 674-680.
33.	Kaufmann KB, Baar W, Glatz T, et al. Epidural analgesia and avoidance of blood transfusion are associated with reduced mortality in patients with postoperative pulmonary complications following thoracotomic esophagectomy: a retrospective cohort study of 335 patients. BMC Anesthesiol, 2019, 19(1): 162. doi: 10.1186/s12871-019-0832-5.
34.	Bennett S, Baker LK, Martel G, et al. The impact of perioperative red blood cell transfusions in patients undergoing liver resection: a systematic review. HPB (Oxford), 2017, 19(4): 321-330.
35.	Zhu S, Cheng Z, Hu Y, et al. Prognostic Value of the Systemic Immune-Inflammation Index and Prognostic Nutritional Index in Patients With Medulloblastoma Undergoing Surgical Resection. Front Nutr, 2021, 8: 754958. doi:10.3389/fnut.2021.754958.
36.	梁秋豪, 马敏杰, 蔺瑞江, 等. 预后营养指数在达芬奇机器人食管癌McKeown术后并发症的应用价值. 中国胸心血管外科临床杂志: 1-9[2023-04-02]. http://kns.cnki.net/kcms/detail/51.1492.R.20221115.1418.008.html.
37.	杨丹丹, 蒋琳芝, 李丽燕, 等. 预后营养指数对老年急性缺血性脑卒中患者静脉溶栓后短期功能预后的预测价值. 中华老年心脑血管病杂志, 2023, 25(1): 39-43.
38.	Matsuda T, Umeda Y, Matsuda T, et al. Preoperative prognostic nutritional index predicts postoperative infectious complications and oncological outcomes after hepatectomy in intrahepatic cholangiocarcinoma. BMC Cancer, 2021, 21(1): 708. doi: 10.1186/s12885-021-08424-0.

1. Miskovic A, Lumb AB. Postoperative pulmonary complications. Br J Anaesth, 2017, 118(3): 317-334.
2. Jammer I, Wickboldt N, Sander M, et al. Standards for definitions and use of outcome measures for clinical effectiveness research in perioperative medicine: European Perioperative Clinical Outcome (EPCO) definitions: a statement from the ESA-ESICM joint taskforce on perioperative outcome measures. Eur J Anaesthesiol, 2015, 32(2): 88-105.
3. 张四梅, 安睿, 刘琳, 等. 围手术期液体治疗对经典原位肝移植术后早期肺部并发症的影响. 中华外科杂志, 2019, 57(6): 440-446.
4. Dou XJ, Wang QP, Liu WH, et al. Effect of cardiac output-guided hemodynamic management on acute lung injury in pediatric living donor liver transplantation. World J Gastrointest Surg, 2022, 14(9): 1037-1048.
5. Wang H, Xing R, Li X, et al. Risk factors for pulmonary complications after laparoscopic liver resection: a multicenter retrospective analysis. Surg Endosc, 2023, 37(1): 510-517.
6. Shoka M, Kanda M, Ito S, et al. Systemic inflammation score as a predictor of pneumonia after radical resection of gastric cancer: analysis of a multi-institutional dataset. Dig Surg, 2020, 37(5): 401-410.
7. Smith CJ, Bray BD, Hoffman A, et al. Can a novel clinical risk score improve pneumonia prediction in acute stroke care? A UK multicenter cohort study. J Am Heart Assoc, 2015, 4(1): e001307. doi: 10.1161/JAHA.114.001307.
8. 庄红霞, 荆晓雷, 王雪琪, 等. 帕金森病患者脑深部电刺激术后肺部并发症列线图预测模型的构建及其预测价值. 中华神经医学杂志, 2021, 20(3): 233-239.
9. Kostakis ID, Sotiropoulos GC, Kouraklis G. Pneumocystis jirovecii pneumonia in liver transplant recipients: a systematic review. Transplant Proc, 2014, 46(9): 3206-3208.
10. Pedersen MR, Choi M, Brink JA, et al. Pretransplant factors and associations with postoperative respiratory failure, ICU length of stay, and short-term survival after liver transplantation in a high MELD population. J Transplant, 2016, 2016: 6787854. doi: 10.1155/2016/6787854.
11. Cardoso FS, Karvellas CJ. Respiratory complications before and after liver transplant. J Intensive Care Med, 2019, 34(5): 355-363.
12. Chen C, Yang D, Gao S, et al. Development and performance assessment of novel machine learning models to predict pneumonia after liver transplantation. Respir Res, 2021, 22(1): 94. doi: 10.1186/s12931-021-01690-3.
13. 罗文婷, 曹丽, 吕德珍, 等. 基于PNI、SII、CAR的列线图模型对肝移植术后腹腔感染的预测价值. 器官移植, 2022, 13(4): 503-508.
14. Li X, Chen C, Wei X, et al. Retrospective comparative study on postoperative pulmonary complications after orthotopic liver transplantation using the Melbourne Group Scale (MGS-2) diagnostic criteria. Ann Transplant, 2018, 23: 377-386.
15. Chen D, Ding Y, Zhu W, et al. Frailty is an independent risk factor for postoperative pulmonary complications in elderly patients undergoing video-assisted thoracoscopic pulmonary resections. Aging Clin Exp Res, 2022, 34(4): 819-826.
16. Li X, Wei X, Chen C, et al. N-acetylcysteine inhalation improves pulmonary function in patients received liver transplantation. Biosci Rep, 2018, 38(5): BSR20180858. doi: 10.1042/BSR20180858.
17. Magalhães CBA, Nogueira IC, Marinho LS, et al. Exercise capacity impairment can predict postoperative pulmonary complications after liver transplantation. Respiration, 2017, 94(3): 272-278.
18. 刘新阳, 张慧, 郑智滢, 等. 313例原位肝移植受者术后早期肺部并发症危险因素分析. 中华器官移植杂志, 2022, 43(3): 141-145.
19. Xiaowei M, Wei Z, Qiang W, et al. Assessment of systemic immune-inflammation index in predicting postoperative pulmonary complications in patients undergoing lung cancer resection. Surgery, 2022, 172(1): 365-370.
20. Tong C, Liu Y, Wu J. Development and validation of a novel nomogram for postoperative pulmonary complications following minimally invasive esophageal cancer surgery. Updates Surg, 2022, 74(4): 1375-1382.
21. Dai Y, Sun G, Hu H, et al. Risk factors for postoperative pulmonary complications in elderly patients receiving elective colorectal surgery: A retrospective study. Front Oncol, 2022, 12: 1002025. doi: 10.3389/fonc.2022.1002025. eCollection 2022.
22. Xue Q, Wen D, Ji MH, et al. Developing machine learning algorithms to predict pulmonary complications after emergency gastrointestinal surgery. Front Med (Lausanne), 2021, 8: 655686. doi: 10.3389/fmed.2021.655686.
23. Baar W, Semmelmann A, Knoerlein J, et al. Risk factors for postoperative pulmonary complications leading to increased in-hospital mortality in patients undergoing thoracotomy for primary lung cancer resection: A multicentre retrospective cohort study of the german thorax registry. J Clin Med, 2022, 11(19): 5774. doi: 10.3390/jcm11195774.
24. Fan Chiang YH, Lee YW, Lam F, et al. Smoking increases the risk of postoperative wound complications: a propensity score-matched cohort study. Int Wound J, 2023, 20(2): 391-402.
25. Lumb AB. Pre-operative respiratory optimisation: an expert review. Anaesthesia, 2019, 74 Suppl 1: 43-48.
26. Wang B, Chen Z, Zhao R, et al. Development and validation of a nomogram to predict postoperative pulmonary complications following thoracoscopic surgery. PeerJ, 2021, 9: e12366. doi: 10.7717/peerj.12366.
27. 左静, 刘喻萍, 金奇彦, 等. 2型糖尿病患者术前血糖水平与肺切除术后肺部并发症之间的关系. 中国胸心血管外科临床杂志: 1-8[2023-03-28]. http://kns.cnki.net/kcms/detail/51.1492.R.20220223.1111.002.html.
28. Cavayas YA, Eljaiek R, Rodrigue É, et al. Preoperative diaphragm function is associated with postoperative pulmonary complications after cardiac surgery. Crit Care Med, 2019, 47(12): e966-e974. doi: 10.1097/CCM.0000000000004027.
29. Wang Y, Hu X, Su MC, et al. Postoperative elevations of neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios predict postoperative pulmonary complications in non-small cell lung cancer patients: a retrospective cohort study. Curr Med Sci, 2020, 40(2): 339-347.
30. 张四梅, 安睿, 刘琳, 等. 围手术期液体治疗对经典原位肝移植术后早期肺部并发症的影响. 中华外科杂志, 2019, 57(6): 440-446.
31. Chandler D, Mosieri C, Kallurkar A, et al. Perioperative strategies for the reduction of postoperative pulmonary complications. Best Pract Res Clin Anaesthesiol, 2020, 34(2): 153-166.
32. 胡嫒, 陈唯韫, 黄宇光. 输血相关急性肺损伤发病机制及防治措施研究进展. 中国医学科学院学报, 2020, 42(5): 674-680.
33. Kaufmann KB, Baar W, Glatz T, et al. Epidural analgesia and avoidance of blood transfusion are associated with reduced mortality in patients with postoperative pulmonary complications following thoracotomic esophagectomy: a retrospective cohort study of 335 patients. BMC Anesthesiol, 2019, 19(1): 162. doi: 10.1186/s12871-019-0832-5.
34. Bennett S, Baker LK, Martel G, et al. The impact of perioperative red blood cell transfusions in patients undergoing liver resection: a systematic review. HPB (Oxford), 2017, 19(4): 321-330.
35. Zhu S, Cheng Z, Hu Y, et al. Prognostic Value of the Systemic Immune-Inflammation Index and Prognostic Nutritional Index in Patients With Medulloblastoma Undergoing Surgical Resection. Front Nutr, 2021, 8: 754958. doi:10.3389/fnut.2021.754958.
36. 梁秋豪, 马敏杰, 蔺瑞江, 等. 预后营养指数在达芬奇机器人食管癌McKeown术后并发症的应用价值. 中国胸心血管外科临床杂志: 1-9[2023-04-02]. http://kns.cnki.net/kcms/detail/51.1492.R.20221115.1418.008.html.
37. 杨丹丹, 蒋琳芝, 李丽燕, 等. 预后营养指数对老年急性缺血性脑卒中患者静脉溶栓后短期功能预后的预测价值. 中华老年心脑血管病杂志, 2023, 25(1): 39-43.
38. Matsuda T, Umeda Y, Matsuda T, et al. Preoperative prognostic nutritional index predicts postoperative infectious complications and oncological outcomes after hepatectomy in intrahepatic cholangiocarcinoma. BMC Cancer, 2021, 21(1): 708. doi: 10.1186/s12885-021-08424-0.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Factors influencing pulmonary complications after liver transplantation and the construction of a predictive model

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content