Risk Factors Of Fever In Patients With Portal Hypertensive After Splenectomy

Objective: To analyse the incidence and main risk factors of fever in patients with portal hypertension of cirrhosis after spleenectomy and portaazygous devascularization according to the clinical data of patients undergoing spleenectomy and portaazygous devascularization.Methods: Patients in Lanzhou University Second Hospital, Lanzhou University First Hospital, General Hospital of Lanzhou Military Region and Gansu Provincial Hospital, who were diagnosed cirrhotic protal hypertension and underwent spleenectomy and portaazygous devascularization, were included in the study. We monitored and recorded the age, sex, having hypertension or diabetes mellitus or not, combining with viral hepatitis or not, bleeding history, C hild-Pugh classification, portal vein pressure, operation time, bleeding volum intraoperative and having portal vein thrombosis or not. At the same time, we recorded platelet count, prothrombintime, activated partial thromboplastin time, fibrinogen and D-dimer at 1 day before and 3, 7, 14 days after operation by exsanguinating check. We also recorded width of main portal vein and average blood flow velocity of portal vein at 1 day before and 3, 7, 14 days after operation by portal color ultrasonography examining. At the same time, we measured the temperature from axillas by mercury thermometer. Based on the outcome of fever, the patients were divided into group test and group control. After the operation, if the temperature recurrently exceeded 38.0 degrees Celsius and durated for at least 7days, we arranged the patients into group test.Otherwise, we arranged the patients into group control. Then we assessed the incidence and major risk factors of fever after spleenectomy and portaazygous devascularization, plotted ROC and caculated the area under the curve to evaluate the diagnose performance by SPSS19.0 software.Results: 154 patients with portal hypertension of cirrhosis underwent spleenectomy and portaazygous devascularization were included in the study, 36 of this patients were into group test and 118 of this patients were into group control. The incidence of fever durated at least 7 days after spleenectomy and portaazygous devascularization was 23.4%(36/154). Single factor analysis showed that fever was related to bleeding history, portal vein pressure, Child-Pugh classification, time of operation, bleeding volum intraoperative, the platelet count of 7 days and 14 days after operation. Logistic regression mode l showed that the main risk factors were the worse Child-Pugh classfication of liver function, longer time of operation, higher blood loss, higher portal vein pressure with odds ratios 2.439, 2.896, 2.018, 1.683 respectively. When the regression model was applied to forecast whether each patient had fever after splenectomy or not, the coincidence rate was 79.2%. We evaluated the diagnose performance that Child-Pugh classification>portal vein pressure> intraoperative bleeding volum >time of operation(AUC: 0.727?0.717?0.687?0.660) by ROC.Conclusion: The incidence of fever in patients with portal hypertension of cirrhosis after spleenectomy and portaazygous devascularization is 23.4%. Worse Child-Pugh classification, higher time of operation, higher intraoperative bleeding volum, higher portal vein pressure are the main risk factors of fever after spleenectomy and portaazygous devascularization of portal hypertension.