Neurological events after liver transplantation: a single-center experience

Abstract

SummaryThe aim of this study was to identify potential risk factors linked to neurologic events (NE) occurring after liver transplantation (LT) and use them to construct a model to predict such events. From odds ratios (OR) of risk factors, a scoring system was assessed using multivariate regression analysis. Forty-one of 307 LT patients presented NE (13.3%), with prolonged hospital stay and decreased post-LT survival. On multivariate analysis, factors associated with NE included: severe pre-LT ascites OR 3.9 (1.80-8.41; P = 0.001), delta sodium ≥12 mEq/l OR 3.5 (1.36-8.67; P = 0.01), and post-LT hypomagnesemia OR 2.9 (1.37-5.98; P = 0.005). Points were assigned depending on ORs as follows: ascites 4 points, and hypomagnesemia and delta sodium ≥12 mEq/l, 3 points each (score range = 0-10 points). ROC curve analysis suggested good discriminative power for the model, with a c-statistic of 0.72 (CI 0.62-0.81; P < 0.0001), best performance for a cutoff value >3 points (71% sensitivity, 60% specificity). NE risk increased progressively from 6.4%, to 10.3%, 12.8%, 31.5% and 71.0% as scores rose from 0 to 3, 4, 6-7 and 10 cumulative points, respectively. The score described helps to identify patients potentially at risk for neurologic events, and its prevention would decrease morbidity and mortality after LT.

Incidence, risk factors, and outcomes related with neurological events after liver transplantation in adult and pediatric recipients

“…To avoid potential information bias, two independent investigators reviewed the collected data. Pretransplant recipient variables and laboratory values included for the analysis were those previously reported by other authors as linked to NE, namely recipient age, gender, alcohol‐related liver disease in adults, presence or history of HE West Haven criteria grade ≥II, pretransplant serum sodium, serum creatinine, and presence of clinically severe ascites . The latter was defined as requirement of at least one therapeutic paracentesis.…”

“…Post‐LT variables included renal replacement therapy, serum sodium and magnesium levels, concomitant drugs used, and units of BPC during transplant surgery. Differences between serum sodium levels immediately before LT and up to 48 hours after LT, defined as delta sodium of ≥12 mEq/L, were considered indicative of increased risk for developing ODS .…”

“…Reported incidence rates of NE are heterogeneous, ranging from 9% to 48% . Possible causes of this complication include the following: surgical complexity, structural CNS changes resulting from prior HE, metabolic disturbances including hypomagnesemia or serum sodium changes, severe ascites, and drugs used in the early post‐LT period, particularly immunosuppressors …”

Sarcopenia is associated with hypertension in older adults: a systematic review and meta-analysis

“…Six studies were conducted in China [18,19,28,31], two each in Republic of Korea [8] and Japan [26], and United States [9,25,34,35], one each in Turkey [30], Switzerland [27], Italy [7], and Spain [29].…”

Sarcopenic is associated with hypertension in older adults: a systematic review and meta-analysis

“…Six studies were conducted in China [16,17,26,29], two in Republic of Korea [8]and Japan [24], andUnited States [9,23,30,31], one in Turkey [28], Switzerland [25], Italy [7], and Spain [27]. Most of the studies were cross-sectional studies except two cohort studies [7,9].…”