Karaciğer nakli yapılan hastalarda erken dönem sağkalım oranlarının tespiti ve preoperatif nötrofil/lenfosit oranının erken dönem sağkalım üzerindeki prediktif değerinin retrospektif analizi
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Dosyalar
Tarih
2021
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Yayıncı
Ege Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Giriş ve Amaç: Karaciğer nakli yapılan hastalarda prognozun ön görülebilmesi, daha ağır seyir gösterebilecek olan hastaların önceden seçilebilmesini ve takiplerinin buna göre ayarlanmasını mümkün hale getirecektir. Bu retrospektif kohort çalışmasında karaciğer nakli yapılan hastaların erken dönem sağkalım durumları, bu sağkalım durumu ile ilişkili olabilecek preoperatif parametreler ve preoperatif nötrofil bölü lenfosit oranının (NLO) sağkalım durumu üzerindeki prediktif etkisinin araştırılması amaçlanmıştır. Gereç- Yöntem: Hastanemizde Ocak 2008 – Aralık 2019 arasında karaciğer nakli yapılan erişkin 400 hasta retrospektif olarak değerlendirmeye alındı. 18 yaş altı, kimlik ve protokol bilgileri olmayan, eksik verileri olan hastalar çalışmaya dahil edilmedi. Hastaların nakil öncesi değerlendirmedeki demografik verilerinin, laboratuvar değerlerinin, eşlik eden kronik hastalıklarının, etiyolojik faktörlerin, MELD-Na skorunun, Child Pugh skorunun, Hepatoselüler kanser varlığının, portal ven trombozu varlığının ve NLO’nun nakil sonrası erken dönem (1.hafta, 1.ay ve 3.ay sürelerindeki) sağkalım durumu üzerindeki etkisi araştırılmıştır. Bulgular: Çalışmaya dahil edilen 400 hastanın 250 (%67,5)’si erkek, 150 (%32,5)’si kadın; yaş ortalaması 51,4±12,4 yıldır. Siroz tanısı hastaların 355 (%88,75)’inde mevcutken, 129 (%32,25) hastada Hepatoselüler Karsinom tanısı vardır. Hastaların 203 (%50,7)’ü canlı vericiden, 196 (%49)’sı ise kadaverik vericiden nakil olmuştur. Nakil öncesi değerlendirmede hastaların 30’unda (%7,5) Child Pugh sınıfı A iken, 110 (%27,5)’unda sınıf B, 260 (%65)’ında ise sınıf C’dir. Nakil öncesi hastaların ortalama MELD-Na skoru 20,18±8,27 olarak saptanmıştır. Nakil öncesi laboratuvar değerlendirmesine göre hastaların ortalama nötrofil bölü lenfosit oranı (NLO) 4,14±4,66 olarak bulunmuştur. Hastaların 1.haftada %92,75, 1.ayda %85,5 ve 3.ayda %80,25 oranında sağkalım gösterdiği görülmüştür. Tek değişkenli analizde cinsiyetin, nakil öncesi total bilirubin değerinin, nakil öncesi NLO’nun ve nakil öncesi MELD-Na skorunun hastaların nakil sonrası 1.hafta, 1.ay ve 3.aydaki sağkalımları üzerinde istatistiksel olarak anlamlı etki yaptığı gösterilmiştir (p<0,05). Sonuç: Çalışmamızda nakil öncesi laboratuvar değerlerinden TBİL, MELD-Na skorunun ve NLO’nun, nakil sonrası 1.hafta, 1.ay ve 3.aylık izlemlerde vefat eden hastalarda daha yüksek olduğu saptanmıştır. Çalışmamızda MELD-Na skorunun bu üç zaman aralığındaki sağkalım durumuna etkisi için roc analizi yapılmış ve bu skor için sınır değeri (cut-off) 1.haftada >22, 1.ay için >24 ve 3.ay için >15 olarak bulunmuştur (p<0,05). Çalışmamızda roc analizi ile NLO için sınır değeri 1.hafta için >3,6, 1.ay ve 3.ay içinse >4,3 olarak belirlenmiş ve belirlenen değerlere göre yapılan Log-Rank testinde hazard oranı (%95 güven aralığı) sırasıyla 1.hafta için 4,37 (2,03-9,38), 1.ay için 4,76 (2,64-8,61) ve 3.ay için 4,33 (2,59-7,23) olarak bulunmuştur (p<0,05). Ayrıca NLO ve MELD-Na skorunun roc eğrilerinin karşılaştırılması yapılmış ve aralarında istatistiksel olarak anlamlı bir fark saptanmamıştır. Tek değişkenli analizde anlamlı olarak bulunan parametreler çok değişkenli analizle incelenmiş ve NLO yine her 3 sağkalım süresi için de anlamlı olarak bulunmuştur (p<0,05). Çalışmamıza göre daha önceki çalışmalarda kanser, kardiyovasküler hastalıklar ve sepsiste mortalite belirteci olarak kullanılan NLO’nun karaciğer nakli sonrası erken dönemdeki sağkalım durumu için anlamlı ve bağımsız bir belirteç olarak kullanılabileceği düşünülmektedir.
Background & Aims: Predicting the prognosis in patients undergoing liver transplantation will make it possible to preselect patients who may have a more severe course and adjust their follow-up accordingly. Within this retrospective cohort study, it was aimed to investigate the early survival status of liver transplant patients, preoperative parameters that may be associated with this survival status, and the predictive effect of preoperative neutrophil per lymphocyte ratio (NLR) on survival status. Material & Methods: 400 adult patients who underwent liver transplantation in our hospital between January 2008 and December 2019 were evaluated retrospectively. Patients under the age of 18, without identity and protocol information, and with missing data were not included in the study. The effects of demographic data, laboratory values, concomitant chronic diseases, etiological factors, MELD-Na score, Child Pugh score, presence of hepatocellular cancer, presence of portal vein thrombosis and NLR in the pre-transplant evaluation of the patients in the pre-transplant evaluation on early survival after transplantation (1st week, 1st month and 3rd month after transplant) were investigated. Results: Of the 400 patients included in the study, 250 (67.5%) were male, 150 (32.5%) were female; mean age is 51.4±12.4 years. While the diagnosis of cirrhosis was present in 355 (88.75%) of the patients, 129 (32.25%) patients had a diagnosis of Hepatocellular Carcinoma. Of the patients, 203 (50.7%) were transplanted from a living donor, and 196 (49%) from a cadaveric donor. In the pre-transplant evaluation, 30 (7.5%) of the patients were Child Pugh class A, 110 (27.5%) were class B and 260 (65%) were class C. The mean MELD-Na score of the patients before the transplant was 20.18±8.27. According to the pre-transplant laboratory evaluation, the mean neutrophil per lymphocyte ratio (NLR) of the patients was found to be 4.14±4.66. It was observed that the patients showed a survival rate of 92.75% at the 1st week, 85.5% at the 1st month and 80.25% at the 3rd month. In univariate analysis, it was shown that gender, pre-transplant total bilirubin value, pre-transplant NLR and pre-transplant MELD-Na score had a statistically significant effect on the early survival of patients at 1 week, 1 month and 3 months after transplantation (p < 0.05). Conclusions: In our study, pre-transplant laboratory values such as TBI, MELD-Na score and NLR were found to be higher in patients who died in the 1st week, 1st month and 3rd month follow-ups after transplantation. In our study, roc analysis was performed for the effect of MELD-Na score on survival in these three time intervals, and the cut-off was found to be >22 in the 1st week, >24 in the 1st month and >15 in the 3rd month (p<0.05). İn our study, the cut-off for NLR was determined as >3,6 for the 1st week and >4.3 for the 1st month and 3rd month by roc analysis, and in the Log-Rank test performed according to the determined values, Hazard Ratio was 4,37 (2,03-9,38), for the 1st week, 4,76 (2,64-8,61) for 1st month and 4,33 (2,59-7,23) for the 3rd month, respectively (p<0,05). In addition, the roc curves of NLR and MELD-Na scores were compared and no statistically significant difference was found between them. Parameters found to be significant in univariate analysis were analyzed with multivariate analysis, and NLR was again found to be significant for all 3 survival times (p<0.05). According to our study, it is thought that NLR, which was used as a mortality marker in cancer, cardiovascular diseases and sepsis in previous studies, can be used as a significant and independent marker for early survival after liver transplantation.
Background & Aims: Predicting the prognosis in patients undergoing liver transplantation will make it possible to preselect patients who may have a more severe course and adjust their follow-up accordingly. Within this retrospective cohort study, it was aimed to investigate the early survival status of liver transplant patients, preoperative parameters that may be associated with this survival status, and the predictive effect of preoperative neutrophil per lymphocyte ratio (NLR) on survival status. Material & Methods: 400 adult patients who underwent liver transplantation in our hospital between January 2008 and December 2019 were evaluated retrospectively. Patients under the age of 18, without identity and protocol information, and with missing data were not included in the study. The effects of demographic data, laboratory values, concomitant chronic diseases, etiological factors, MELD-Na score, Child Pugh score, presence of hepatocellular cancer, presence of portal vein thrombosis and NLR in the pre-transplant evaluation of the patients in the pre-transplant evaluation on early survival after transplantation (1st week, 1st month and 3rd month after transplant) were investigated. Results: Of the 400 patients included in the study, 250 (67.5%) were male, 150 (32.5%) were female; mean age is 51.4±12.4 years. While the diagnosis of cirrhosis was present in 355 (88.75%) of the patients, 129 (32.25%) patients had a diagnosis of Hepatocellular Carcinoma. Of the patients, 203 (50.7%) were transplanted from a living donor, and 196 (49%) from a cadaveric donor. In the pre-transplant evaluation, 30 (7.5%) of the patients were Child Pugh class A, 110 (27.5%) were class B and 260 (65%) were class C. The mean MELD-Na score of the patients before the transplant was 20.18±8.27. According to the pre-transplant laboratory evaluation, the mean neutrophil per lymphocyte ratio (NLR) of the patients was found to be 4.14±4.66. It was observed that the patients showed a survival rate of 92.75% at the 1st week, 85.5% at the 1st month and 80.25% at the 3rd month. In univariate analysis, it was shown that gender, pre-transplant total bilirubin value, pre-transplant NLR and pre-transplant MELD-Na score had a statistically significant effect on the early survival of patients at 1 week, 1 month and 3 months after transplantation (p < 0.05). Conclusions: In our study, pre-transplant laboratory values such as TBI, MELD-Na score and NLR were found to be higher in patients who died in the 1st week, 1st month and 3rd month follow-ups after transplantation. In our study, roc analysis was performed for the effect of MELD-Na score on survival in these three time intervals, and the cut-off was found to be >22 in the 1st week, >24 in the 1st month and >15 in the 3rd month (p<0.05). İn our study, the cut-off for NLR was determined as >3,6 for the 1st week and >4.3 for the 1st month and 3rd month by roc analysis, and in the Log-Rank test performed according to the determined values, Hazard Ratio was 4,37 (2,03-9,38), for the 1st week, 4,76 (2,64-8,61) for 1st month and 4,33 (2,59-7,23) for the 3rd month, respectively (p<0,05). In addition, the roc curves of NLR and MELD-Na scores were compared and no statistically significant difference was found between them. Parameters found to be significant in univariate analysis were analyzed with multivariate analysis, and NLR was again found to be significant for all 3 survival times (p<0.05). According to our study, it is thought that NLR, which was used as a mortality marker in cancer, cardiovascular diseases and sepsis in previous studies, can be used as a significant and independent marker for early survival after liver transplantation.
Açıklama
Anahtar Kelimeler
Karaciğer Nakli, Karaciğer Sirozu, Hepatoselüler Kanser, Nötrofil Lenfosit Oranı, Sağkalım, Liver Transplantation, Liver Cirrhosis, Hepatocellular Cancer, Neutrophil Lymphocyte Ratio, Survival
