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Abstract：
Background Neurologic events during primary stay in heart transplant (HTx) recipients may be associated with reduced outcome and survival, which we aim to explore with the current study. Methods and Results We screened and included all patients undergoing HTx in our center between September 2010 and December 2022 (n=268) and checked for the occurrence of neurologic events within their index stay. Neurologic events were defined as ischemic stroke, hemorrhage, hypoxic ischemic injury, or acute symptomatic neurologic dysfunction without central nervous system injury. The cohort was then divided into recipients with (n=33) and without (n=235) neurologic events after HTx. Using a multivariable Cox regression model, the association of neurologic events after HTx and survival was assessed. Recipients with neurologic events displayed a longer intensive care unit stay (30 versus 16 days; P=0.009), longer mechanical ventilation (192 versus 48 hours; P<0.001), and higher need for blood transfusion, and need for hemodialysis after HTx was substantially higher (81% versus 55%; P=0.01). Resternotomy (36% versus 26%; P=0.05) and mechanical life support (extracorporeal life support) after HTx (46% versus 24%; P=0.02) were also significantly higher in patients with neurologic events. Covariable-adjusted multivariable Cox regression analysis revealed a significant independent association of neurologic events and increased 30-day (hazard ratio [HR], 2.5 [95% CI, 1.0-6.0]; P=0.049), 1-year (HR, 2.2 [95% CI, 1.1-4.3]; P=0.019), and overall (HR, 2.5 [95% CI, 1.5-4.2]; P<0.001) mortality after HTx and reduced Kaplan-Meier survival up to 5 years after HTx (P<0.001). Conclusions Neurologic events after HTx were strongly and independently associated with worse postoperative outcome and reduced survival up to 5 years after HTx.
摘要：
背景：心脏移植（HTx）受者初次住院期间的神经系统事件可能与预后和生存率降低有关。我们的目标是用目前的研究来探索。方法和结果我们筛选并纳入了2010年9月至2022年12月在我们中心接受HTx的所有患者（n=268），并检查了其住院时间内的神经系统事件的发生。神经系统事件定义为缺血性卒中，出血,缺氧缺血性损伤，或没有中枢神经系统损伤的急性症状性神经功能障碍。然后将队列分为在HTx后有（n=33）和没有（n=235）神经系统事件的接受者。使用多变量Cox回归模型，对HTx术后神经系统事件与生存率的相关性进行了评估.患有神经系统事件的受者显示出更长的重症监护病房住院时间（30天对16天；P=0.009），机械通气时间更长（192对48小时；P<0.001），更需要输血，HTx后对血液透析的需求明显更高(81%对55%;P=0.01)。在有神经系统事件的患者中，HTx后的胆固醇（36％对26％；P=0.05）和机械生命支持（体外生命支持）（46％对24％；P=0.02）也显着更高。Covariable-adjusted多变量Cox回归分析显示，神经系统事件和30天增加之间存在显著的独立关联（风险比[HR]，2.5[95%CI，1.0-6.0]；P=0.049)，1年（HR，2.2[95%CI，1.1-4.3]；P=0.019)，和总体(HR，2.5[95％CI，1.5-4.2];P<0.001）HTx后死亡率和HTx后5年Kaplan-Meier生存率降低（P<0.001）。结论HTx术后的神经系统事件与不良的术后预后和HTx术后5年生存率降低密切相关。
