P039: PSOAS MUSCLE INDEX CAN PREDICT DURATION OF MECHANICAL VENTILATION IN PATIENTS UNDERGOING LIVER TRANSPLANT
Lemuel S Paredes, MD1, Guillermo R Silguero, MD1, Rahul V Shabadi, MD1, Fouad G Souki, MD, MS2, Ramona Nicolau-Raducu, MD, PhD2; 1Jackson Memorial Hospital, 2University of Miami
Introduction: Sarcopenia is a common complication of cirrhosis; its diagnosis and implications remain unknown in patients undergoing liver transplantation (LTx).
Methods: Out of 197 patients who underwent LTx in 2016-2017, 146 patients had abdominal CT scans 6 months prior to LTx. Preoperative sarcopenia was assessed by measuring the right and left psoas muscle area via transverse CT sections at the third lumbar vertebra level. Average psoas mass index (PMI, cm2/m2) was reported. One intraoperative death was excluded. Nominal logistic regression was used to determine the risk factors associated with prolong mechanical ventilation. Patients in the lowest median PMI, stratified by gender, were deemed sarcopenic.
Results: The median duration of mechanical ventilation post LTx was 20 (1-902) hours. The median MELD score was 26 (6-52), with a MELD score> 30 in 39% (56/145) of the patients. More than half (54% (79/145)) of the patients were extubated within first 24 h, while 84% (122/145) were extubated within 72 hours. Patients with mechanical ventilation duration >24 h had a statistically significant decrease in 1-year survival: 86% (57/66) versus 95% (77/79) for ≤ 24h (χ2=6.3, P=0.0119). Multivariable analysis identified that pre-transplant hospitalization (χ2=23.9, P<0.0001), presence of TIPS (χ2=5.7, P=0.0167), donor risk index (χ2=4.2, P=0.0396) and low PMI (χ2=3.8, P=0.0486) were statistically significant risk factors for prolong mechanical ventilation>24h (χ2=47, P<0.0001). A C-index statistic of 0.80 was calculated for this group of risk factors. A PMI < 2.93 cm2/m2 was found in 50% (43/86) of men and a PMI <2.29 cm2/m2 was found in 49% (29/59) of woman. For men there is statistically increased risk of mechanical ventilation > 24 hours for PMI < 2.93 cm2/m2 of 56% (24/43) versus 28% (12/43) for PMI ≥ 2.93 cm2/m2 (χ2=6.9, P=0.0087). However for woman the risk of mechanical ventilation for PMI <2.29 cm2/m2 was not statistically different: 47% (14/30) versus 55% (16/29) for PMI ≥ 2.29 cm2/m2 (χ2=0.47, P=0.5135).
Conclusion: In present study, we revealed that low PMI in men is a predictive factor for mechanical ventilation>24h in patients undergoing LTx, along with other risk factors such us pre-transplant hospitalization, TIPS and quality of donor graft.