Volume 11 Issue 4
Jul.  2020
Turn off MathJax
Article Contents
Article Navigation >  ORGAN TRANSPLANTATION  > 2020  >  11(4): 477-481
Chen Junguo, Wang Hao, Xie Bin, et al. Risk factor analysis and predictors assessment for postoperative delirium in liver transplantation[J]. ORGAN TRANSPLANTATION, 2020, 11(4): 477-481. doi: 10.3969/j.issn.1674-7445.2020.04.009
Citation: Chen Junguo, Wang Hao, Xie Bin, et al. Risk factor analysis and predictors assessment for postoperative delirium in liver transplantation[J]. ORGAN TRANSPLANTATION, 2020, 11(4): 477-481. doi: 10.3969/j.issn.1674-7445.2020.04.009
shu

Risk factor analysis and predictors assessment for postoperative delirium in liver transplantation

doi: 10.3969/j.issn.1674-7445.2020.04.009

  • Department of Liver Transplantation, Organ Transplantation Center, the Second Xiangya Hospital of Central South University, Changsha 410011, China

More Information
  • Corresponding author: Li Ting, Email: liting001@csu.edu.cn
  • Received Date: 2020-04-11
    Available Online: 2021-01-19
  • Publish Date: 2020-07-15
    Abstract
  •   Objective  To analyze the risk factors and predictors related to postoperative delirium(POD) in liver transplantation.  Methods  The clinical data of 232 liver transplant recipients were retrospectively analyzed. Recipients were assigned to POD group (n=60) and non-POD (n=172) group according to the presence of POD. The intra- and post-operative conditions were compared between the two groups of liver transplant recipients. The risk factors for occurrence of POD in liver transplant recipients were analyzed using multifactorial analysis. And the value of predicting the occurrence of POD in liver transplant recipients according to the risk factors were assessed.  Results  The incidence of POD in liver transplant recipients was 25.9%. The operation time and anhepatic phase in the POD group were longer than those in the non-POD group. Intraoperative infusion of erythrocyte, infusion of cryoprecipitate, and lactic acid level were higher than those in the non-POD group (all P < 0.05). The levels of postoperative alanine aminotransferase (ALT), aspartate aminotransferase (AST), prothrombin time international normalized ratio (PT-INR), and plasma fibrinogen in the POD group were significantly higher than those in the non-POD group (all P < 0.05). Preoperative hepatic encephalopathy, elevated blood ammonia, high score of model for end-stage liver disease (MELD), elevated postoperative AST level and long intraoperative anhepatic phase were the independent risk factors for POD in liver transplant recipients (all P < 0.05). Preoperative elevated blood ammonia and high MELD score showed profound value in predicting the occurrence of POD in liver transplant recipients, with best cut-off values of 42.6 μmol/L and 18 points, sensitivity of 0.650 and 0.767 as well as specificity of 0.826 and 0.727, respectively.  Conclusions  The incidence of POD is high in liver transplant recipients. Preoperative hepatic encephalopathy, elevated blood ammonia, high MELD score, elevated postoperative AST level, and long intraoperative anhepatic phase are independent risk factors for liver transplant POD. Preoperative elevated blood ammonia and high MELD score are predictors of POD in transplant recipients.

     

    • FullText(HTML)
  • loading
    • References(26)
  • [1]
    SETTERS B, SOLBERG LM. Delirium[J]. Prim Care, 2017, 44(3):541-559. DOI: 10.1016/j.pop.2017.04.010.
    [2]
    REDDY SV, IRKAL JN, SRINIVASAMURTHY A. Postoperative delirium in elderly citizens and current practice[J]. J Anaesthesiol Clin Pharmacol, 2017, 33(3): 291-299. DOI: 10.4103/joacp.JOACP_180_16.
    [3]
    HSHIEH TT, INOUYE SK, OH ES. Delirium in the elderly[J]. Psychiatr Clin North Am, 2018, 41(1):1-17. DOI: 10.1016/j.psc.2017.10.001.
    [4]
    MARCANTONIO ER. Delirium in hospitalized older adults[J]. N Engl J Med, 2017, 377(15):1456-1466. DOI: 10.1056/NEJMcp1605501.
    [5]
    RENGEL KF, PANDHARIPANDE PP, HUGHES CG. Postoperative delirium[J]. Presse Med, 2018, 47(4 Pt 2): e53-e64. DOI: 10.1016/j.lpm.2018.03.012.
    [6]
    BHATTACHARYA B, MAUNG A, BARRE K, et al. Postoperative delirium is associated with increased intensive care unit and hospital length of stays after liver transplantation[J]. J Surg Res, 2017, 207:223-228. DOI: 10.1016/j.jss.2016.08.084.
    [7]
    LEE H, OH SY, YU JH, et al. Risk factors of postoperative delirium in the intensive care unit after liver transplantation[J]. World J Surg, 2018, 42(9):2992-2999. DOI: 10.1007/s00268-018-4563-4.
    [8]
    OLIVER N, BOHORQUEZ H, ANDERS S, et al. Post-liver transplant delirium increases mortality and length of stay[J]. Ochsner J, 2017, 17(1):25-30. http://www.ncbi.nlm.nih.gov/pubmed/28331444
    [9]
    KALVAS LB, MONROE TB. Structural brain changes in delirium: an integrative review[J]. Biol Res Nurs, 2019, 21(4):355-365. DOI: 10.1177/1099800419849489.
    [10]
    OH ES, FONG TG, HSHIEH TT, et al. Delirium in older persons: advances in diagnosis and treatment[J]. JAMA, 2017, 318(12):1161-1174. DOI: 10.1001/jama.2017.12067.
    [11]
    BUTTERWORTH RF. Hepatic encephalopathy in cirrhosis: pathology and pathophysiology[J]. Drugs, 2019, 79(Suppl 1):17-21. DOI: 10.1007/s40265-018-1017-0.
    [12]
    WINTERDAHL M, ABBAS Z, NOER O, et al. Cerebral water content mapping in cirrhosis patients with and without manifest HE[J]. Metab Brain Dis, 2019, 34(4):1071-1076. DOI: 10.1007/s11011-019-00427-y.
    [13]
    LI JL, JIANG H, ZHANG XD, et al. Microstructural brain abnormalities correlate with neurocognitive dysfunction in minimal hepatic encephalopathy: a diffusion kurtosis imaging study[J]. Neuroradiology, 2019, 61(6):685-694. DOI: 10.1007/s00234-019-02201-4.
    [14]
    LIN W, CHEN X, GAO YQ, et al. Hippocampal atrophy and functional connectivity disruption in cirrhotic patients with minimal hepatic encephalopathy[J]. Metab Brain Dis, 2019, 34(6):1519-1529. DOI: 10.1007/s11011-019-00457-6.
    [15]
    MONTOLIU C, FELIPO V. Current state of knowledge of hepatic encephalopathy (part Ⅱ): changes in brain white matter tracts integrity are associated with cognitive deficits in minimal hepatic encephalopathy[J]. Metab Brain Dis, 2016, 31(6):1359-1360. doi: 10.1007/s11011-016-9909-8
    [16]
    GROVER VP, CROSSEY MM, FITZPATRICK JA, et al. Quantitative magnetic resonance imaging in patients with cirrhosis: a cross-sectional study[J]. Metab Brain Dis, 2016, 31(6):1315-1325. doi: 10.1007/s11011-015-9716-7
    [17]
    MANCINI A, CAMPAGNA F, AMODIO P, et al. Gut : liver : brain axis: the microbial challenge in the hepatic encephalopathy[J]. Food Funct, 2018, 9(3):1373-1388. DOI: 10.1039/c7fo01528c.
    [18]
    WANG W, GU L, VERKHRATSKY A, et al. Ammonium increases TRPC1 expression via Cav-1/PTEN/AKT/GSK3β pathway[J]. Neurochem Res, 2017, 42(3):762-776. DOI: 10.1007/s11064-016-2004-z.
    [19]
    LU K, ZIMMERMANN M, GÖRG B, et al. Hepatic encephalopathy is linked to alterations of autophagic flux in astrocytes[J]. EBioMedicine, 2019, 48:539-553. DOI: 10.1016/j.ebiom.2019.09.058.
    [20]
    HERTZ L, SONG D, PENG L, et al. Multifactorial effects on different types of brain cells contribute to ammonia toxicity[J]. Neurochem Res, 2017, 42(3):721-736. DOI: 10.1007/s11064-016-1966-1.
    [21]
    GÖRG B, KARABABA A, HÄUSSINGER D. Hepatic encephalopathy and astrocyte senescence[J]. J Clin Exp Hepatol, 2018, 8(3):294-300. DOI: 10.1016/j.jceh.2018.05.003.
    [22]
    GÖRG B, KARABABA A, SCHÜTZ E, et al. O-GlcNAcylation-dependent upregulation of HO1 triggers ammonia-induced oxidative stress and senescence in hepatic encephalopathy[J]. J Hepatol, 2019, 71(5):930-941. DOI: 10.1016/j.jhep.2019.06.020.
    [23]
    OJA SS, SARANSAARI P, KORPI ER. Neurotoxicity of ammonia[J]. Neurochem Res, 2017, 42(3):713-720. DOI: 10.1007/s11064-016-2014-x.
    [24]
    FIATI KENSTON SS, SONG X, LI Z, et al. Mechanistic insight, diagnosis, and treatment of ammonia-induced hepatic encephalopathy[J]. J Gastroenterol Hepatol, 2019, 34(1):31-39. DOI: 10.1111/jgh.14408.
    [25]
    LABAYEN I, RUIZ JR, HUYBRECHTS I, et al. Ideal cardiovascular health and liver enzyme levels in European adolescents; the HELENA study[J]. J Physiol Biochem, 2017, 73(2):225-234. DOI: 10.1007/s13105-016-0546-9.
    [26]
    CROOME KP, LEE DD, BURNS JM, et al. Intraregional model for end-stage liver disease score variation in liver transplantation: disparity in our own backyard[J]. Liver Transpl, 2018, 24(4):488-496. DOI: 10.1002/lt.25021.
    • Relative Articles
    • Supplements(0)
    • Cited By
  • 加载中

Catalog

    通讯作者: 陈斌, bchen63@163.com
    • 1. 

      沈阳化工大学材料科学与工程学院 沈阳 110142

    1. 本站搜索
    2. 百度学术搜索
    3. 万方数据库搜索
    4. CNKI搜索

    Figures(1)  / Tables(1)

    Get Citation
    PDF
    XML

    Article Metrics

    Article views (169) PDF downloads(18) Cited by()
    Proportional views
    Related

    WeChat Subscription Account

    Wechat Service Account

    Contact Us
    • Tel：020-38736410
    • Email: organtranspl@163.com
    • Address：The Third Affiliated Hospital of Sun Yat-sen University, No. 600, Tianhe Road, Tianhe District, Guangzhou
    • Editorial Office of Organ Transplantation  粤ICP备2021030844号
    Links

    Supported by: Beijing Renhe Information Technology Co. Ltd    

    /

    DownLoad:  Full-Size Img  PowerPoint
    Return
    Return