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在肝移植中预测大量输血:麦克卢斯基风险指数20年后修订

Jacopo Belfiore¹, Gabriella Licitra², Alessandro Cardu¹

¹Transplant Anesthesia and Critical Care, Azienda Ospedaliera Universitaria Pisana, University School of Medicine, Pisa, Italy.

Blood transfusion = Trasfusione del sangue

|September 3, 2025

概括

修订后的风险指数改善了肝移植 (LT) 大量输血的预测. 新模型 (revMcRI) 结合了现代因素,提高了患者血液管理和LT手术风险分层.

科学领域:

移植手术
肝病学
输血医学

背景情况:

肝移植对于末期肝病 (ESLD) 来说至关重要.
大规模的术后输血 (MT) 是LT期间的一个重大问题.
现有的麦克卢斯基风险指数 (McRI) 可能不反映当前的 LT 实践.

研究的目的:

在当代LT队列中评估McRI的有效性.
开发一个包含新的预测因子的修订后的McRI (revMcRI).
改善LT患者的MT风险分层.

主要方法:

在604名LT患者的追溯观察队列研究中.
对人口,临床和实验室数据进行分析,以确定MT预测因子 (≥6个PRBC单位/24小时).
使用后勤回归和AUROC分析开发和验证revMcRI.

主要成果:

24. 7% 的患者需要MT.
原来的McRI显示出预测有效性,但错过了当代风险因素.
包括MELD得分和DCD在内的revMcRI显示出优异的预测性能 (AUROC 0. 8121).

结论:

该 revMcRI 提高了 LT 中 MT 预测的准确性.
这种精细的模型有助于术前风险分层和术后血液管理.
建议对revMcRI进行进一步的多中心验证.

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