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首页> 外文期刊>Surgical Endoscopy >A pre-operative platelet transfusion algorithm for patients with cirrhosis and hepatocellular carcinoma undergoing laparoscopic microwave ablation
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A pre-operative platelet transfusion algorithm for patients with cirrhosis and hepatocellular carcinoma undergoing laparoscopic microwave ablation

机译：腹腔镜微波消融肝硬化和肝细胞癌患者患者前血小板输血算法

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Background Thrombocytopenia is a common finding in patients with chronic liver disease. It is associated with poor clinical outcomes due to increased risk of bleeding after even minor procedures. We sought to determine an algorithm for pre-operative platelet transfusion in patients with cirrhosis and hepatocellular carcinoma (HCC) undergoing laparoscopic microwave ablation (MIS-MWA). Methods A retrospective review identified all patients with cirrhosis and HCC who underwent MIS-MWA at a single tertiary institution between 2007 and 2019. Demographics, pre-operative and post-operative laboratory values, transfusion requirements, and bleeding events were collected. The analyzed outcome of bleeding risk included any transfusion received intra-operatively or a transfusion or surgical intervention post-operatively. Logistic regression models were created to predict bleeding risk and identify patients who would benefit from pre-operative transfusion. Results There were 433 patients with cirrhosis and HCC who underwent MIS-MWA identified; of these, 353 patients had complete laboratory values and were included. Bleeding risk was evaluated through bivariate analysis of statistically and clinically significant variables. The accuracy of both models was substantiated through bootstrap validation for 500 iterations (model 1: ROC 0.8684, Brier score 0.0238; model 2: ROC 0.8363, Brier score 0.0252). The first model captured patients with both thrombocytopenia and anemia: platelet count 10 gm/dL (OR 0.16, p 0.026, CI 0.031-0.80). Conclusion The prediction of patients with cirrhosis and HCC requiring pre-operative platelet transfusions may help to avoid bleeding complications after invasive procedures. This study needs to be prospectively validated and ultimately may be beneficial in assessment of novel therapies for platelet-based clinical treatment in liver disease.
机译：背景血小板减少症在慢性肝病患者中很常见。即使是很小的手术，由于出血风险增加，它也会导致不良的临床结果。我们试图确定接受腹腔镜微波消融（MIS-MWA）的肝硬化和肝细胞癌（HCC）患者术前血小板输注的算法。方法回顾性分析2007年至2019年间在一所高等院校接受MIS-MWA治疗的所有肝硬化和肝癌患者。收集人口统计学、术前和术后实验室值、输血要求和出血事件。出血风险的分析结果包括术中输血或术后输血或手术干预。我们建立了逻辑回归模型来预测出血风险，并确定哪些患者会从术前输血中受益。结果共有433例肝硬化和肝癌患者接受MIS-MWA检查；其中353名患者具有完整的实验室检查值，并被纳入研究。通过对具有统计学和临床意义的变量进行双变量分析，评估出血风险。两个模型的准确性通过500次迭代的自举验证得到证实（模型1:ROC 0.8684，Brier评分0.0238；模型2:ROC 0.8363，Brier评分0.0252）。第一个模型捕获了血小板减少症和贫血患者：血小板计数10 gm/dL（OR 0.16，P0.026，CI 0.031-0.80）。结论预测肝硬化和肝癌患者术前需要输注血小板可能有助于避免侵入性手术后出血并发症。这项研究需要进行前瞻性验证，最终可能有助于评估以血小板为基础的肝病临床治疗的新疗法。

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