Risk index for early infections following living donor liver transplantation

Abstract

Introduction Post-operative infections in patients undergoing living donor liver transplantation (LDLT) are a major cause of morbidity and mortality. This study aims to develop a practical and efficient prognostic index for early identification and possible prediction of post-transplant infections using risk factors identified by multivariate analysis. Material and methods One hundred patients with post-hepatitic cirrhosis, HCV positive, genotype 4, Child B/C or MELD score 13-25 undergoing LDLT were included. All potential predictors of infection were analyzed by backward logistic regression. Cut-off values were obtained from ROC curve analysis. Significant predictors were combined into a risk index, which was further tested and compared by ROC curve analysis. Results Post-operative infection was associated with a significantly higher mortality (50.7% vs. 33.3%). Total leucocyte count, total bilirubin, early biliary complications, fever and C-reactive protein were found to be independent predictors of early infectious complications after LDLT. The risk index predicted infection with the highest sensitivity and specificity as compared with each predictor on its own (AUC = 0.91, 95% CI: 0.830–0.955, p < 0.0001). Conclusions The use of a combined risk index for early diagnosis of post-operative infections can efficiently identify high risk patients.

Postoperative fever after liver resection: Incidence, risk factors, and characteristics associated with febrile infectious complication

“…There were few studies on the relationship between fever, infection, and other postoperative outcomes in patients who undergo PLOS ONE liver surgery. In a study of risk factors related to infections following living donor liver transplantation, Elkholy et al [55] indicated that fever was an independent predictor of early infectious complication. In our study, the incidence of infection in patients with POF was 24.5%.…”

Artificial Intelligence May Predict Early Sepsis After Liver Transplantation

“…In the septic shock phase of the disease, every hour that treatment is delayed can lead to a 7.6% increase in mortality (Kumar et al, 2006 ). In liver transplantation, this phenomenon is not different in the general population, and an early infection due to surgical complications, such as bleeding, bile leak, or rejection, may trigger infections and sepsis with severe consequences in recipients (Kumar et al, 2006 ; Elkholy et al, 2019 ).…”

“…A number of recent studies have applied artificial intelligence (AI) and machine learning to identify patients at risk for sepsis earlier, thereby potentially reducing mortality and morbidity (Kumar et al, 2006 ; Nemati et al, 2018 ; Elkholy et al, 2019 ). These methods have typically used an array of clinical and laboratory variables in the electronic medical record (EMR) to predict the risk of sepsis.…”