In‐hospital postoperative infection after heart transplantation: Risk factors and development of a novel predictive score

医学 回顾性队列研究 逻辑回归 糖尿病 移植 风险因素 外科 内科学 并发症 观察研究 机械通风 逐步回归 心脏移植 重症监护室 内分泌学
作者
Paula Fernández Ugidos,Eduardo Barge‐Caballero,Rocío Gómez‐López,María J. Paniagua‐Martín,Gonzalo Barge‐Caballero,David Couto‐Mallón,Miguel Solla‐Buceta,Carmen Iglesias‐Gil,Vanesa Aller‐Fernández,Miguel González‐Barbeito,José Manuel Vázquez‐Rodríguez,María G. Crespo‐Leiro
出处
期刊:Transplant Infectious Disease [Wiley]
卷期号:21 (4) 被引量:8
标识
DOI:10.1111/tid.13104
摘要

Abstract Introduction Infection is one of the most significant complications following heart transplantation (HT). The aim of this study was to identify specific risk factors for early postoperative infections in HT recipients, and to develop a multivariable predictive model to identify HT recipients at high risk. Methods A single‐center, observational, and retrospective study was conducted . The dependent variable was in‐hospital postoperative infection. We examined demographic and epidemiological data from donors and recipients, surgical features, and adverse postoperative events as independent variables. Backwards, stepwise multivariable logistic regression with a P ‐value < 0.05 was used to identify clinical factors independently associated with the risk of in‐hospital postoperative infections following HT. Results Six hundred seventy‐seven patients were included in this study. During the in‐hospital postoperative period, 348 episodes of infection were diagnosed in 239 (35.9%) patients. Seven variables were identified as independent clinical predictors of early postoperative infection after HT: history of diabetes mellitus, previous sternotomy, preoperative mechanical ventilation, primary graft failure, major surgical bleeding, use of mycophenolate mofetil, and use of itraconazole. Based on the results of multivariable models, we constructed a 7‐variable (8‐point) score to predict the risk of in‐hospital postoperative infection in HT recipients , which showed a reasonable ability to predict the risk of in‐hospital postoperative infection in this population. Prospective external validation of this new score is warranted to confirm its clinical applicability. Conclusions In‐hospital postoperative infection is a common complication after HT, affecting 35% of patients who underwent this procedure at our institution. Diabetes mellitus, previous sternotomy, preoperative mechanical ventilation, primary graft failure, major surgical bleeding, use of mycophenolate mofetil, and itraconazole were all independent clinical predictors of early postoperative infection after HT.
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