Exploring the risk factors of early sepsis after liver transplantation: development of a novel predictive model

Wanting Chen; Shengdong Wu; Lingwen Gong; Yu Guo; Li Wei; Haoran Jin; Yan Zhou; Chuanshuang Li; Caide Lu; Lanman Xu

doi:10.3389/fmed.2023.1274961

Exploring the risk factors of early sepsis after liver transplantation: development of a novel predictive model

Front Med (Lausanne). 2023 Nov 29:10:1274961. doi: 10.3389/fmed.2023.1274961. eCollection 2023.

Authors

Wanting Chen¹, Shengdong Wu², Lingwen Gong¹, Yu Guo¹, Li Wei¹, Haoran Jin¹, Yan Zhou¹, Chuanshuang Li¹, Caide Lu², Lanman Xu^{1

3}

Affiliations

¹ Department of Infectious Diseases and Liver Diseases, Ningbo Medical Centre Lihuili Hospital, Affiliated Lihuili Hospital of Ningbo University, Ningbo, China.
² Department of Hepatopancreatobiliary Surgery, Ningbo Medical Center Lihuili Hospital, Affiliated Lihuili Hospital of Ningbo University, Ningbo, China.
³ Department of Infectious Diseases, Zhejiang Provincial Key Laboratory for Accurate Diagnosis and Treatment of Chronic Liver Diseases, The First Affiliated Hospital of Wenzhou Medical University, Hepatology Institute of Wenzhou Medical University, Wenzhou, China.

Abstract

Background: Sepsis is a severe and common complication of liver transplantation (LT) with a high risk of mortality. However, effective tools for evaluating its risk factors are lacking. Therefore, this study identified the risk factors of early post-liver transplantation sepsis and established a nomogram.

Methods: We analyzed the risk factors of post-liver transplantation sepsis in 195 patients. Patients with infection and a systemic inflammatory response syndrome (SIRS) score ≥ 2 were diagnosed with sepsis. The predictive indicators were screened with the least absolute shrinkage and selection operator (LASSO) and collinearity analyses to develop a nomogram. The prediction performance of the new nomogram model, Sequential Organ Failure Assessment (SOFA) score, and Modified Early Warning Score (MEWS) was compared through assessment of the area under the curve (AUC), decision curve analysis (DCA), net reclassification index (NRI), and integrated discrimination improvement (IDI).

Results: The nomogram was based on postoperative heart rate, creatinine concentration, PaO₂/FiO₂ ratio < 400 mmHg, blood glucose concentration, and international normalized ratio. The AUC of the nomogram, the SOFA score, and MEWS were 0.782 (95% confidence interval CI: 0.716-0.847), 0.649 (95% CI: 0.571-0.727), and 0.541 (95% CI: 0.469-0.614), respectively. The DCA curves showed that the net benefit rate of the nomogram was higher than that of the SOFA score and MEWS. The NRI and IDI tests revealed better predictive performance for the nomogram than SOFA score and MEWS.

Conclusion: Heart rate, creatinine concentration, PaO₂/FiO₂, glucose concentration, and international normalized ratio should be monitored postoperatively for patients at risk of post-liver transplantation sepsis. The nomogram based on the aforementioned risk factors had a better predictive performance than SOFA score and MEWS.

Keywords: liver; predictive model; risk factors; sepsis; transplantation.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This work was supported by Foundation of Zhejiang Provincial Key Laboratory for Accurate Diagnosis and Treatment of Chronic Liver Disease (grant number 2020E10014-002), major participant: LX; Ningbo Medical and Health Brand Discipline (grant number PPXK2018-03), project leader: SW; Natural Science Foundation of Zhejiang Province, China (grant number LY21H030004), project leader: LX; Natural Science Foundation of Ningbo City, (grant number 2022J253), project leader: LX; and Key Technology R&D Project of Ningbo City (grant number 2023Z208), project leader: LX.