Correlation between preoperation hepatic function and short to medium term mortality after heart transplantation

Abstract

Objective To evaluate the correlation between preoperation hepatic function and mortality after heart transplantation using the Receiver Operating Characteristic(ROC) curves and Kaplan-Meier survival analysis. Meanwhile determining the Optimal Operating Point(OOP) and doubtable value interval of the significant indicator for studing it with short to medium term survival analysis. Methods To collect statistical data of 91 cases with heart transplantation in the heart transplantation centre of Anzhen Hospital from January 2009 to June 2014, including the last preoperation hepatic function index. Containing alanine aminotransferase(ALT), aspartate aminotransferase(AST), total protein(TP), albumin(ALB), ratio of albumin and globulin(A/G), serum total bilirubin(STB), connect bilirubin(CB), ratio of connect bilirubin and serum total bilirubin CB/STB, etc. Plotting the ROC curves for all variables in perioperation using SPSS 17.0 statistical software, firstly. Next, to determine the significant indicator according to the area under the ROC curve(AUC)(AUC>0.7), and to find OOP/Youden index and doubtable value interval of the significant index. And then, total cases were divided into three groups according to doubtable value points. Finally, using Kaplan-Meier survival analysis to reveal the variation tendency of three survival cures for different groups. Results The ratio of albumin and globulin is the sole variable associated with mortality in perioperation, and AUC=0.825(SE=0.056, P=0.000, 95%CI=0.715~0.936). Paients whose A/G≤1.13 had significantly lower survival rates than the other two groups in short to medium postoperative term, P<0.001. But after 32 months, the variation tendency of three groups tended to stability. Conclusion The preoperative ratio of albumin and globulin of patient and postoperative mortality were related, but the correlation decreased with the increase of time. The short to medium term survival rates declined significantly for patients whose A/G≤1.13. So preoperative A/G could forecast the prognosis of paitents as reference indicator. Key words: Heart transplantation; Hepatic function; Ratio of albumin and globulin; Mortality