A model to predict the development of mental status changes of unclear cause after liver transplantation

Fasiha Kanwal, David Chen, Lena Ting, Jeffrey Gornbein, Sammy Saab, Francisco Durazo, Hasan Yersiz, Douglas Farmer, R. Mark Ghobrial, Ronald W. Busuttil, Steven Huy Han

Research output: Contribution to journalArticle

31 Scopus citations

Abstract

Postoperative mental status changes are common after liver transplantation (LT). A clear cause of these mental status changes cannot be identified in a significant proportion of patients. In adult liver transplant recipients, our goals are to: (1) identify independent predictors for the development of post-LT mental status changes of unclear cause and (2) derive a practical formula to predict the risk for developing this complication by using simple clinical parameters. Eligible patients had documented mental status changes of at least 3 days' duration, occurring within 1 month of LT. Exclusion criteria were known structural brain disorders, major organ dysfunction, or metabolic causes of altered mentation. Age- and sex-matched controls were liver transplant recipients without post-LT neurological sequelae. Data were collected on preoperative, intraoperative, and postoperative variables. Univariate and multivariate analyses were performed to detect factors predictive of the development of post-LT mental status of unclear cause. There were 40 cases and 40 controls. Independent predictors of mental status changes of unclear cause included alcoholic and metabolic liver diseases; pre-LT mechanical ventilation; Model for End-Stage Liver Disease (MELD) score greater than 15; and nonelective LT. Using these four preoperative factors, a simple predictive rule was developed. Risk for developing altered mental status of unclear cause after LT was 78% to 89% if all four predictors were present versus 0.8% to 2.4% if no predictors were present. In conclusion, alcoholic and metabolic liver diseases, pre-LT mechanical ventilation, MELD score greater than 15, and nonelective LT are independent predictive factors for post-LT altered mental status changes of unclear cause. A simple model can be used to calculate the risk for developing altered mental status post-LT.

Original languageEnglish (US)
Pages (from-to)1312-1319
Number of pages8
JournalLiver Transplantation
Volume9
Issue number12
DOIs
StatePublished - Dec 2003

ASJC Scopus subject areas

  • Surgery
  • Hepatology
  • Transplantation

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