肝切除术后并发症风险评估及患者管理优化模型。

IF 2.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hpb Pub Date : 2025-04-12 DOI:10.1016/j.hpb.2025.04.008

Fabio Procopio , Jacopo Galvanin , Guido Costa , Laura Rocchi , Federico Piccioni , Maurizio Cecconi , Guido Torzilli

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引用次数: 0

摘要

背景：早期发现主要并发症并及时采取治疗措施可以改善肝切除术后患者的预后。本研究的目的是建立一个预测肝切除术后并发症风险的模型，并帮助确定需要在重症监护病房（ICU）密切监测的患者。方法：选取2010年至2021年间在意大利人道主义研究医院（Humanitas Research Hospital）接受肝切除术的患者。我们使用术前、术中及联合预测因子建立了预测Clavien-Dindo III-V型并发症的三个模型。模型的性能通过自举在内部进行评估。结果：1497例患者中，7%出现Clavien-Dindo III-V型并发症。术前模型纳入肿瘤病理、肿瘤负荷、既往化疗、肝脏特征、临床门静脉高压症、心脏病、肌酐、总蛋白水平。除了这些变量外，肝切除术类型、手术时间、额外手术程序和输血也被纳入联合模型。术前、术中、联合模型的bootstrap校正c指数分别为0.68、0.70、0.72。在所有模型中，超过1000次bootstrap的主要并发症预测概率中位数与观察到的概率接近。结论：这些预后模型有助于识别重大并发症高危患者，指导患者个体决策和术后icu护理评估。观察到的模型性能的乐观性需要外部验证。

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Model for estimating the risk of postoperative morbidity and optimizing patients' management after hepatectomy

Background

Early detection of major complications and immediate therapeutic interventions may improve patient outcome after hepatectomy. The aim of the present study was to develop a model predicting the risk of postoperative complications after hepatectomy and help identify patients who require close-monitoring in intensive care unit (ICU).

Methods

Patients underwent hepatectomy at Humanitas Research Hospital, Italy, between 2010 and 2021 were considered. We used preoperative, intraoperative and combined predictors to build three models predicting Clavien-Dindo III-V complications. Model performances was evaluated internally via bootstrapping.

Results

Of 1497 patients, 7% had Clavien-Dindo III-V complications. Tumor pathology, tumor burden, previous chemotherapy, liver characteristics, clinical portal hypertension, cardiopathy, creatinine and total protein level were incorporated in the preoperative model. In addition to these variables, type of hepatectomy, operation time, additional surgical procedure, and transfusion were incorporated into the combined model. The bootstrap corrected C-indices for preoperative, intraoperative and combined models were 0.68, 0.70 and 0.72. The median predicted probability of major complications over-1000 bootstraps was close to observed probabilities for all models.

Conclusion

These prognostic models may help identify patients at high-risk of major complication and guide decision-making for individual patients and postoperative ICU-care assessment. Observed optimism in model performance necessitates external validation.

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来源期刊

Hpb GASTROENTEROLOGY & HEPATOLOGY-SURGERY

CiteScore

5.60

自引率

3.40%

发文量

244

审稿时长

57 days

期刊介绍： HPB is an international forum for clinical, scientific and educational communication. Twelve issues a year bring the reader leading articles, expert reviews, original articles, images, editorials, and reader correspondence encompassing all aspects of benign and malignant hepatobiliary disease and its management. HPB features relevant aspects of clinical and translational research and practice. Specific areas of interest include HPB diseases encountered globally by clinical practitioners in this specialist field of gastrointestinal surgery. The journal addresses the challenges faced in the management of cancer involving the liver, biliary system and pancreas. While surgical oncology represents a large part of HPB practice, submission of manuscripts relating to liver and pancreas transplantation, the treatment of benign conditions such as acute and chronic pancreatitis, and those relating to hepatobiliary infection and inflammation are also welcomed. There will be a focus on developing a multidisciplinary approach to diagnosis and treatment with endoscopic and laparoscopic approaches, radiological interventions and surgical techniques being strongly represented. HPB welcomes submission of manuscripts in all these areas and in scientific focused research that has clear clinical relevance to HPB surgical practice. HPB aims to help its readers - surgeons, physicians, radiologists and basic scientists - to develop their knowledge and practice. HPB will be of interest to specialists involved in the management of hepatobiliary and pancreatic disease however will also inform those working in related fields. Abstracted and Indexed in: MEDLINE® EMBASE PubMed Science Citation Index Expanded Academic Search (EBSCO) HPB is owned by the International Hepato-Pancreato-Biliary Association (IHPBA) and is also the official Journal of the American Hepato-Pancreato-Biliary Association (AHPBA), the Asian-Pacific Hepato Pancreatic Biliary Association (A-PHPBA) and the European-African Hepato-Pancreatic Biliary Association (E-AHPBA).