PDF(Pubmed)
Abstract：
Objectives: Risk assessment models for cardiac surgery do not distinguish between degrees of liver dysfunction. We have previously shown that preoperative liver stiffness is associated with hospital length of stay following cardiac surgery. The authors hypothesized that a liver stiffness measurement (LSM) ≥ 9.5 kPa would rule out a short hospital length of stay (LOS < 6 days) following isolated coronary artery bypass grafting (CABG) surgery. Methods: A prospective observational study of one hundred sixty-four adult patients undergoing non-emergent isolated CABG surgery at a single university hospital center. Preoperative liver stiffness measured by ultrasound elastography was obtained for each participant. Multivariate logistic regression models were used to assess the adjusted relationship between LSM and a short hospital stay. Results: We performed multivariate logistic regression models using short hospital LOS (<6 days) as the dependent variable. Independent variables included LSM (< 9.5 kPa, ≥ 9.5 kPa), age, sex, STS predicted morbidity and mortality, and baseline hemoglobin. After adjusting for included variables, LSM ≥ 9.5 kPa was associated with lower odds of early discharge as compared to LSM < 9.5 kPa (OR: 0.22, 95% CI: 0.06-0.84, p = 0.03). The ROC curve and resulting AUC of 0.76 (95% CI: 0.68-0.83) suggest the final multivariate model provides good discriminatory performance when predicting early discharge. Conclusions: A preoperative LSM ≥ 9.5 kPa ruled out a short length of stay in nearly 80% of patients when compared to patients with a LSM < 9.5 kPa. Preoperative liver stiffness may be a useful metric to incorporate into preoperative risk stratification.
摘要：
目的：心脏手术的风险评估模型无法区分肝功能障碍的程度。我们先前已经表明，术前肝硬度与心脏手术后住院时间有关。作者假设肝脏硬度测量（LSM）≥9.5kPa将排除孤立冠状动脉旁路移植术（CABG）手术后住院时间短（LOS<6天）。方法：一项前瞻性观察性研究，在一家大学医院中心对164名接受非紧急隔离CABG手术的成年患者进行了观察。通过超声弹性成像测量每个参与者的术前肝脏硬度。使用多变量逻辑回归模型来评估LSM与住院时间短之间的调整关系。结果：我们使用短住院LOS（<6天）作为因变量进行了多变量逻辑回归模型。独立变量包括LSM(<9.5kPa，≥9.5kPa),年龄,性别,STS预测发病率和死亡率，和基线血红蛋白。调整包含的变量后，与LSM<9.5kPa相比，LSM≥9.5kPa与较低的早期出院几率相关（OR：0.22，95％CI：0.06-0.84，p=0.03）。ROC曲线和所得AUC为0.76（95％CI：0.68-0.83）表明，最终的多变量模型在预测早期出院时提供了良好的判别性能。结论：与LSM<9.5kPa的患者相比，术前LSM≥9.5kPa排除了近80％的患者住院时间短。术前肝脏硬度可能是纳入术前风险分层的有用指标。
