Establishment of a Risk Prediction Model for Prolonged Mechanical Ventilation After Liver Transplantation: A Multicenter Retrospective Study

IF 2.5 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Journal of Hepato‐Biliary‐Pancreatic Sciences Pub Date : 2026-10-22 Epub Date: 2026-07-27 DOI:10.1002/jhbp.70160

Xuejiao Zhou, Jing Hu, Zeliang Xu, Di Jiang, Yao Xie, Xingchao Liu, Guangkai Zhao, Shaohua Song, Xishu Wang, Qingyi Zhang

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引用次数: 0

Abstract

Purpose

To identify risk factors for prolonged mechanical ventilation (PMV) after liver transplantation (LT) and to develop and internally validate a predictive nomogram.

Methods

A multicenter retrospective cohort of 746 LT recipients (January 2015–June 2023) was randomly split 7:3 into training (n = 522) and validation (n = 224) sets. We conducted univariate and multivariate logistic regression to identify factors linked to PMV. A risk nomogram was created based on the multivariate analysis, and its performance was evaluated for calibration, discrimination, and clinical utility, with internal validation using the Validation Set data.

Results

The incidence of PMV was 21.6%. Multivariate analysis identified five independent predictors of PMV: ASA scores ≥ 3, mechanical ventilation before LT, MELD score, albumin levels, and anhepatic phase. The nomogram developed from these predictors showed a concordance index (C-index) of 0.780 (95% CI, 0.734–0.827) and demonstrated good calibration. After internal validation, the model maintained a C-index of 0.731 (95% CI, 0.653–0.810). Decision curve analysis and clinical impact curve confirmed the nomogram's effectiveness.

Conclusion

The nomogram enables individualized PMV risk estimation in LT recipients and may guide early intervention and resource allocation.

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肝移植术后延长机械通气风险预测模型的建立：一项多中心回顾性研究。

目的：确定肝移植（LT）后延长机械通气（PMV）的危险因素，并开发和内部验证预测图。方法：746名LT接受者（2015年1月- 2023年6月）的多中心回顾性队列随机分为训练组（n = 522）和验证组（n = 224）。我们进行了单变量和多变量逻辑回归，以确定与PMV相关的因素。基于多变量分析创建风险nomogram，评估其校准、鉴别和临床效用，并使用validation Set数据进行内部验证。结果：PMV发病率为21.6%。多因素分析确定了PMV的5个独立预测因素：ASA评分≥3分、LT前机械通气、MELD评分、白蛋白水平和无肝期。由这些预测因子建立的nomogram显示一致性指数（C-index）为0.780 (95% CI, 0.734-0.827)，具有良好的校准性。经内部验证，模型c指数维持在0.731 （95% CI, 0.653-0.810）。决策曲线分析和临床影响曲线证实了nomogram的有效性。结论：nomogram可对肝移植受者进行个体化的PMV风险评估，并可指导早期干预和资源分配。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Hepato‐Biliary‐Pancreatic Sciences GASTROENTEROLOGY & HEPATOLOGY-SURGERY

自引率

10.00%

发文量

178

审稿时长

6-12 weeks

期刊介绍： The Journal of Hepato-Biliary-Pancreatic Sciences (JHBPS) is the leading peer-reviewed journal in the field of hepato-biliary-pancreatic sciences. JHBPS publishes articles dealing with clinical research as well as translational research on all aspects of this field. Coverage includes Original Article, Review Article, Images of Interest, Rapid Communication and an announcement section. Letters to the Editor and comments on the journal’s policies or content are also included. JHBPS welcomes submissions from surgeons, physicians, endoscopists, radiologists, oncologists, and pathologists.