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. 2023 Nov 29:10:1274961.
doi: 10.3389/fmed.2023.1274961. eCollection 2023.

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

Wanting Chen  1 , Shengdong Wu  2 , Lingwen Gong  1 , Yu Guo  1 , Li Wei  1 , Haoran Jin  1 , Yan Zhou  1 , Chuanshuang Li  1 , Caide Lu  2 , Lanman Xu  1   3
Affiliations

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

Wanting Chen et al. Front Med (Lausanne). .

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.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Study flow chart. The enrolled patients were divided into sepsis and sepsis-free groups within two weeks after LT.
Figure 2
Figure 2
Nomogram to predict the risk of sepsis in patients within two weeks following LT. The nomogram assigned a specific score on the point scale axis for each variable, and these individual scores were summed to calculate the total score. This total score can be projected to estimate the risk of early sepsis after LT. HR, heart rate; Cr, creatinine; INR, international normalized ratio; PaO2/FiO2, PaO2-to-FiO2 ratio; Glu, blood glucose.
Figure 3
Figure 3
Comparison of the performances of the nomogram, SOFA score and MEWS in predicting sepsis. (A) ROC curves of the nomogram, SOFA score and MEWS in predicting risk of sepsis within two weeks after LT and (B) DCA for evaluation of the validity ability of the nomogram, SOFA score and MEWS.
Figure 4
Figure 4
Calibration plot of nomogram in predicting sepsis after LT.
See this image and copyright information in PMC

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