Risk Factors Of Liver Function Injury After Cardiac Valve Surgery With Cardiopulmonary Bypass And Establishment Of Predictive Model

Objective:Liver function injury after cardiac valve surgery with cardiopulmonary bypass(CPB)is one of the common complications after cardiac surgery,which is related to a variety of factors,increasing the length of hospital stay and mortality,and affecting the long-term survival rate after operation.In order to improve the quality of medical treatment,it is necessary to correctly understand the regularity and characteristics of liver function injury after cardiac valve surgery with CPB,and to explore the risk factors of postoperative liver function injury,then establish a prediction model based on these risk factors.Finally,in order to provide a theoretical basis for the prediction,diagnosis and treatment of liver function injury after cardiac valve surgery with CPB.Method:A total of 160 adult patients who received open-heart valve replacement or plastic surgery under CPB from July 2018 to October 2020 in the Department of Cardiovascular Surgery,Affiliated Hospital of North Sichuan Medical College were retrospectively analyzed.The changes of general clinical indicators,serological relevant indicators of liver function before operation and on the 1st,2nd and 6th day after operation were mainly detected.Liver function indicators include alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TIBL),direct bilirubin(DIBL),indirect bilirubin(IBIL),albumin(ALB),prealbumin(PA),alkaline phosphatase(ALP)and cholinesterase(ChE).Postoperative liver function injury According to the WHO evaluation criteria for common adverse reaction terms:Liver function injury is defined as any one of ALT,AST,TBIL,and DBIL exceeding normal values within 48 hours after operation,and further grade liver function injury.The patients were divided into liver injury group and non-liver injury group,univariate analysis was performed first,and then multivariate logistic analysis was performed to establish a regression model for the selected more significant variables,and receiver operating characteristic curve(ROC curve)was used to evaluate the prediction model.Results:1)128 of 160 patients with cardiac valves had postoperative liver function injury,with an incidence of 80%,including 48 cases of grade 1 injury,71 cases of grade 2 injury,9 cases of grade 3 injury,and no grade 4 injury;2 patients died in the hospital,with a mortality rate of 1.2%.2)ALT,AST,TIBL,DIBL,and IBIL showed different degrees of increase,ALB,ALP,PA,and ChE showed different degrees of decrease in the early stage after cardiac valve surgery with CPB,but showed a tendency of recovery expression on the 6th day after surgery.3)Univariate analysis of liver function injury after CPB cardiac valve surgery suggested that preoperative ALT level,preoperative TBIL level,degree of tricuspid valve,CPB time,and aortic cross-clamp time were associated with liver function injury after CPB cardiac valve surgery(P<0.05).Multivariate logistic regression analysis showed that preoperative TBIL level(OR=1.152,95%CI:1.014～1.309,P=0.03),CPB time(OR=1.072,95%CI:1.025～1.121,P=0.002),and aortic cross-clamp time(OR=0.945,95%CI:0.900～0.992,P=0.021)were independent risk factors for liver function injury after CPB cardiac valve surgery.4)Patients with double-valve replacement or plasty were more likely to have postoperative liver function injury than patients with single-valve(P<0.05);patients with postoperative liver function injury had postoperative hospital stay(P<0.05).5)the area under the curve(AUC)of ROC was 0.814(95%CI:1.025～1.121,P<0.001),the cutoff point was 0.5,and the sensitivity of the model was 53.1%and the specificity was 96.9%.Conclusion:1)Hepatic anabolic and metabolic function decreased early after cardiac valve surgery with CPB.2)Preoperative ALT level and tricuspid valve degree are risk factors for liver function injury after CPB cardiac valve surgery;preoperative TBIL level,CPB time,and aortic cross-clamp time are independent risk factors.3)Patients with double-valve are more likely to have postoperative liver function injury than patients with single-valve;patients with postoperative liver function injury have postoperative hospital stay.4)The establishment of a predictive model has some value in predicting the occurrence of postoperative liver function injury.