TY - JOUR
T1 - A model to predict the development of mental status changes of unclear cause after liver transplantation
AU - Kanwal, Fasiha
AU - Chen, David
AU - Ting, Lena
AU - Gornbein, Jeffrey
AU - Saab, Sammy
AU - Durazo, Francisco
AU - Yersiz, Hasan
AU - Farmer, Douglas
AU - Ghobrial, R. Mark
AU - Busuttil, Ronald W.
AU - Han, Steven Huy
N1 - Funding Information:
From the *Division of Digestive Diseases, tDumont-University of California at Los Angeles Liver Transplant Center, Pfleger Liver Institute; and Departments of $Internal Medicine and §Biomathematics, David Geffen School of Medicine at Universi{y of California at Los Angeles, CA. Supported in part by the Tala/ A. Bakr Fellowship in Hepatology (F.K.) and Schering/American Associationf or the Study of Liver Diseases Advanced Hepatology Fellowship (F.K). Address reprint requests to Steven-Huy Han, MD, Dumont-UCLA Liver Transplant Center, PflegerL iver Institute, 200 Medical Plaza, Ste 214, Los Angeles, CA 90095-7302. Telephone: 310-206-6705; FAX.. 310-206-419Z" E-mail: shbhan @ucla.e du. Copyright © 2003 by the American Association for the Study of Liver Diseases 1527-6465/03/0912-0011530. 00/0 doi: l O. l O16/j.lts.20 03. 09. 023
PY - 2003/12
Y1 - 2003/12
N2 - 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.
AB - 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.
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U2 - 10.1016/j.lts.2003.09.023
DO - 10.1016/j.lts.2003.09.023
M3 - Article
C2 - 14625832
AN - SCOPUS:10744224599
SN - 1527-6465
VL - 9
SP - 1312
EP - 1319
JO - Liver Transplantation
JF - Liver Transplantation
IS - 12
ER -