Liver transplantation remains the only curative treatment option for a variety of end-stage liver diseases. Prediction of major adverse events following surgery has traditionally focused on static predictors that are known prior to surgery. The effects of intraoperative management can now be explored due to the archiving of high-resolution monitoring data. We extracted intraoperative hemodynamic trend data of 55 patients undergoing orthotopic liver transplantation (OLT) and computed 12 features from the systolic arterial blood pressure (ABP), cardiac index, central venous pressure (CVP), and stroke volume variation (SVV) signals. Using a logistic regression classifier with a leave-one-out cross-validation procedure, we selected subsets of these features to predict mortality up to 180 days after surgery. Best performance was achieved with a combination of 3 features - median absolute deviation (MAD) of ABP, median CVP, and time spent with SVV < 10% - reaching an area under the receiver-operating characteristic (or c-statistic) of 0.808. Odds ratios (OR) computed from the coefficients of the multivariate logistic regression model constructed from these features showed that greater time spent with SVV < 10% (OR = 0.981 min-1, p = 0.001) and greater MAD of systolic ABP (OR = 0.696 mmHg-1, p = 0.026) were significantly associated with survival. Adding preoperative measures such as age and serum concentrations of albumin, bilirubin, and creatinine failed to improve performance of the prediction model. These results show that the course of intraoperative hemodynamics can predict 180-day mortality after OLT.

Prasad, V., TOSCHI, N., CANICHELLA, A., Marcellucci, M., CONIGLIONE, F., DAURI, M., et al. (2015). Intraoperative hemodynamics predict postoperative mortality in orthotopic liver transplantation. In 37th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (pp. 989-992). Institute of Electrical and Electronics Engineers Inc. [10.1109/EMBC.2015.7318530].

Intraoperative hemodynamics predict postoperative mortality in orthotopic liver transplantation

TOSCHI, NICOLA;CANICHELLA, ANTONIO;CONIGLIONE, FILADELFO;DAURI, MARIO;GUERRISI, MARIA GIOVANNA;
2015

Abstract

Liver transplantation remains the only curative treatment option for a variety of end-stage liver diseases. Prediction of major adverse events following surgery has traditionally focused on static predictors that are known prior to surgery. The effects of intraoperative management can now be explored due to the archiving of high-resolution monitoring data. We extracted intraoperative hemodynamic trend data of 55 patients undergoing orthotopic liver transplantation (OLT) and computed 12 features from the systolic arterial blood pressure (ABP), cardiac index, central venous pressure (CVP), and stroke volume variation (SVV) signals. Using a logistic regression classifier with a leave-one-out cross-validation procedure, we selected subsets of these features to predict mortality up to 180 days after surgery. Best performance was achieved with a combination of 3 features - median absolute deviation (MAD) of ABP, median CVP, and time spent with SVV < 10% - reaching an area under the receiver-operating characteristic (or c-statistic) of 0.808. Odds ratios (OR) computed from the coefficients of the multivariate logistic regression model constructed from these features showed that greater time spent with SVV < 10% (OR = 0.981 min-1, p = 0.001) and greater MAD of systolic ABP (OR = 0.696 mmHg-1, p = 0.026) were significantly associated with survival. Adding preoperative measures such as age and serum concentrations of albumin, bilirubin, and creatinine failed to improve performance of the prediction model. These results show that the course of intraoperative hemodynamics can predict 180-day mortality after OLT.
Settore FIS/07 - Fisica Applicata(Beni Culturali, Ambientali, Biol.e Medicin)
Settore MED/41 - Anestesiologia
Settore MED/18 - Chirurgia Generale
Settore ING-INF/06 - Bioingegneria Elettronica e Informatica
English
Rilevanza internazionale
Articolo scientifico in atti di convegno
Prasad, V., TOSCHI, N., CANICHELLA, A., Marcellucci, M., CONIGLIONE, F., DAURI, M., et al. (2015). Intraoperative hemodynamics predict postoperative mortality in orthotopic liver transplantation. In 37th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (pp. 989-992). Institute of Electrical and Electronics Engineers Inc. [10.1109/EMBC.2015.7318530].
Prasad, V; Toschi, N; Canichella, A; Marcellucci, M; Coniglione, F; Dauri, M; Guerrisi, Mg; Heldt, T
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/2108/134351
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