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Derivation of a risk index for the prediction of massive blood transfusion in liver transplantation
Author(s) -
McCluskey Stuart A.,
Karkouti Keyvan,
Wijeysundera Duminda N.,
Kakizawa Karen,
Ghannam Mohammed,
Hamdy Ahmed,
Grant David,
Levy Gary
Publication year - 2006
Publication title -
liver transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.814
H-Index - 150
eISSN - 1527-6473
pISSN - 1527-6465
DOI - 10.1002/lt.20868
Subject(s) - medicine , liver transplantation , logistic regression , transplantation , creatinine , retrospective cohort study , prothrombin time , surgery , odds ratio , receiver operating characteristic , gastroenterology
Massive blood transfusion (MBT) remains a serious and common occurrence in liver transplantation surgery. This retrospective cohort study was undertaken to identify preoperative predictors of MBT and to develop a risk index for MBT in liver transplantation. Data were retrospectively collected on all liver transplantations carried out at a single institution between January 1998 and March 2004. Multivariable logistic regression analysis was used to identify independent predictor variables of MBT, defined as ≥6 units of red blood cell concentrate (RBC) in the first 24 hours of surgery. The model was internally validated by bootstrapping. Of the 460 liver transplant recipients, 193 (42%) received ≥6 units of RBC within 24 hours of surgery. Unadjusted analyses identified 12 preoperative predictors of MBT: age, height, gender, repeat transplantation, etiology of liver failure, and preoperative laboratory values (hemoglobin concentration, platelet count, international normalized ratio for prothrombin activity [INR], albumin, total bilirubin, and creatinine). In multivariable logistic regression, 7 independent predictors of MBT were identified: age (>40 years), hemoglobin concentration (≤10.0 g/dL), INR (1.2‐1.99, and >2.0), platelet count (≤70 × 10 9 /L), creatinine (≥110 μmol/L for female subjects and ≥120 μmol/L for male subjects), albumin (< 28 g/L), and repeat transplantation. The area under the receiver‐operating characteristic curve (ROC) for the model was 0.82. By using the regression β coefficients to derive weights for each of these predictors, a risk index was developed that assigned each patient a score between 0 and 8. The ROC for this risk index was 0.79. MBT in liver transplantation surgery can be accurately predicted by 7 readily available preoperative predictors. Liver Transpl, 2006. © 2006 AASLD.