Abstract
Profound hypotension during liver transplantation is aggressively treated with vasopressors thus frequently unrevealed in a retrospective study. The relationship between concealed intraoperative hypotension and in-hospital mortality after liver transplantation was evaluated using performance measurement (PM) of systolic arterial pressure (SAP). Median performance error (MDPE), median absolute performance error (MDAPE), and wobble of SAP were calculated using preoperative SAP as the reference value, and prereperfusion and postreperfusion SAPs as measured values. Univariable and multivariable logistic regression analyses were performed using 6 PM parameters and 36 traditional SAP-derived parameters to predict in-hospital mortality. In-hospital mortality was 3.9% (22/569 cases). Prereperfusion MDAPE and postreperfusion wobble were the only significant SAP-derived predictors of in-hospital mortality. The area under receiver operating characteristic curve of prediction model was 0.769 (95% confidence interval 0.732–0.803, P < 0.001; sensitivity = 55%, specificity = 94%). Severe hypotension during liver transplantation is concealed by proactive vasopressor treatment thus traditional measures of hypotension generally fail to detect the masked hypotension in retrospective analysis. PM analysis of intraoperative SAP including prereperfusion MDAPE and postreperfusion wobble is most likely to detect treated and therefore concealed hypotension, and was able to independently and quantitatively predict in-hospital mortality after liver transplantation with high diagnostic specificity.
Highlights
Patients with advanced liver disease receiving liver transplantation often become hypotensive during surgery
We hypothesized that Performance measurement (PM) parameters of systolic arterial pressure (SAP) would more accurately describe the consequences of hypotension during liver transplantation compared to traditional measures such as mean and time-weighted blood pressures
Non-survivors were associated with older age, higher model for end-stage liver disease (MELD) score, more bleeding and transfusion amount, more frequent use of vasopressors, and longer intensive care unit (ICU) length of stay compared to survivors
Summary
Patients with advanced liver disease receiving liver transplantation often become hypotensive during surgery. Performance measurement (PM) is a set of quantitative measures used in pharmacokinetic research that evaluates the discrepancy between the target or predicted concentration and the measured concentration[5]. In this retrospective study, PM parameters were adapted to measure bias, accuracy, and time-dependent variability in blood pressure during liver transplantation surgery by using median performance error (MDPE), median absolute performance error (MDAPE), and wobble, respectively. The primary aim of our study was to evaluate the association between PM parameters of intraoperative SAP and in-hospital mortality after liver transplantation
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