胆道闭锁儿童肝移植术后90天再入院危险因素分析
收稿日期: 2022-04-18
网络出版日期: 2023-02-16
Risk factors of 90-day readmission after liver transplantation in children with biliary atresia
Received date: 2022-04-18
Online published: 2023-02-16
目的 调查胆道闭锁儿童在肝移植术后90天再入院率及危险因素。方法 回顾性分析上海交通大学医学院附属新华医院、仁济医院和上海儿童医学中心确诊为胆道闭锁，2019年1月1日至2019年12月31日首次接受肝移植手术治疗患儿的临床资料。比较再入院组和未再入院组间临床特征，分析再入院的危险因素。结果 共纳入264例患儿，男124例、女140例，中位年龄6.9（5.6~9.4）月。儿童肝移植术后90天再入院率为22.0%（58/264）。与未再入院组相比，再入院组患儿PELD评分、血清总胆汁酸水平、INR较高，住院时间较长，血小板计数、腰肌面积较低，差异均有统计学意义（P<0.05）。二元logistic回归分析示血小板减少症(OR=2.347,95%CI：1.154~4.776)、血清总胆汁酸水平(OR=1.058,95%CI：1.011~1.106)、腰肌面积(OR=0.615,95%CI：0.301~0.989)、住院时间(OR=1.069, 95%CI：1.031~1.109)是肝移植术后再入院的影响因素（P均<0.05）。结论 血小板减少症、血清总胆汁酸水平升高、腰肌面积减少和住院时间长的儿童，肝移植术后90天再入院的风险更高，建议早期筛查。
万双双 , 徐仁应 , 钱永兵 , 洪莉 , 冯一 . 胆道闭锁儿童肝移植术后90天再入院危险因素分析[J]. 临床儿科杂志, 2023 , 41(2) : 134 -139 . DOI: 10.12372/jcp.2023.22e0452
Objective To investigate the 90-day readmission rate and risk factors of children with biliary atresia (BA) after liver transplantation (LT). Methods This retrospective cohort study was conducted in Xinhua Hospital, Renji Hospital and Shanghai Children's Medical Center affiliated to Shanghai Jiao Tong University School of Medicine from January 1 to December 31, 2019. Data of children with BA who received LT for the first time were retrospectively analyzed. Patients were divided into readmission group and non-readmission group according to whether they were readmitted within 90 days after LT. The differences between the two groups were compared. Logistic regression was used to analyze the risk factors of 90-day readmission. Results A total of 264 children (female 53.0%) were included, with a median age of 6.9 (5.6-9.4) months. The 90-day readmission rate was 22.0% (58 / 264). Compared with the non-readmission group, the readmission group had higher pediatric end-stage liver disease (PELD) score, higher serum total bile acid level (TBA), higher international normalized ratio (INR), longer length of hospital stays (LOS), lower platelet count and lower psoas muscle area (PMA), and all the difference were statistically significant (P<0.05). Binary logistic regression analysis showed that thrombocytopenia (OR =2.347, 95%CI: 1.154-4.776), TBA (OR =1.058, 95% CI: 1.011-1.106), PMA (OR = 0.615, 95% CI: 0.301-0.989), and LOS (OR= 1.069, 95% CI: 1.031-1.109) were the influencing factors of 90-day readmission after pediatric LT, with statistical significance (P<0.05).Conclusions Children with thrombocytopenia, elevated TBA, lower PMA and long LOS had a higher risk of 90-day readmission after LT.
Key words： readmission; biliary atresia; liver transplantation
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