Early lactate clearance as a reliable predictor of initial poor graft function after orthotopic liver transplantation

作     者：Jian-Feng Wu,Rong-Yao Wu,Juan Chen,Bin Ou-Yang,Min-Ying Chen and Xiang-Dong Guan Department of Surgical Intensive Care Unit,First Affiliated Hospital,Sun Yat-Sen University,Guangzhou 510080,China 

作者机构：Department of Surgical Intensive Care Unit First Affliated Hospital Sun Yat-Sen University Guangzhou 510080 China 

出 版 物：《Hepatobiliary & Pancreatic Diseases International》 (国际肝胆胰疾病杂志（英文版）)

年 卷 期：2011年第10卷第6期

页      面：587-592页

核心收录：

学科分类：1002[医学-临床医学] 100210[医学-外科学(含：普外、骨外、泌尿外、胸心外、神外、整形、烧伤、野战外)] 10[医学] 

基　　金：supported by grants from the Natural Science Foundation of Guangdong Province (8151008901000079) the Sun Yat-Sen University Clinical Research 5010 Program(2007015) 

主　　题：early lactate clearance initial poor graft function liver transplantation 

摘      要：BACKGROUND:Initial poor graft function (IPGF) following orthotopic liver transplantation is a major determinant of postoperative survival and *** clearance is a good marker of liver *** this study,we investigated the clinical utility of early lactate clearance as an early and accurate predictor for IPGF following liver ***:This was a prospective observational study of 222 patients referred to the surgical intensive care unit (SICU) after orthotopic liver *** IPGF group consisted of patients with alanine aminotransferase (ALT) and/or aspartate aminotransferase (AST) 1500 IU/L within 72 hours after orthotopic liver *** lactate clearance was defined as lactate at SICU presentation (hour 0) minus lactate at hour 6,divided by lactate at SICU *** model for end-stage liver disease (MELD) score,Child-Pugh score and laboratory data including AST,ALT,total bilirubin (TB) and prothrombin time (PT) were recorded at SICU presentation and compared between the non-IPGF and IPGF groups Receiver operating characteristic (ROC) curves were plotted to measure the performance of early lactate clearance,MELD score,Child-Pugh score,TB and ***:IPGF occurred in 45 of the 222 patients (20.3%).The early lactate clearance in the non-IPGF group was markedly higher than that in the IPGF group (43.2±13.8% vs 13.4±13.7% P0.001).The optimum cut-off value for early lactate clearance predicting IPGF was 24.8% (sensitivity 95.5%,specificity 88.9%).The area under the curve of the ROC was 0.961,which was significantly superior to MELD score,Child-Pugh score TB and *** with early lactate clearance ≤24.8% had a higher IPGF rate (OR=169) and a higher risk of in-hospital mortality (OR=3.625).CONCLUSIONS:Early lactate clearance can serve as a prompt and accurate bedside predictor of *** with early lactate clearance less than 24.8% are associated with a higher incidence of IPGF.