Performance measurement of intraoperative systolic arterial pressure to predict in-hospital mortality in adult liver transplantation

Profound hypotension during liver transplantation is aggressively treated with vasopressors thus frequently unrevealed in a retrospective study. The relationship between concealed intraoperative hypotension and in-hospital mortality after liver transplantation was evaluated using performance measurement (PM) of systolic arterial pressure (SAP). Median performance error (MDPE), median absolute performance error (MDAPE), and wobble of SAP were calculated using preoperative SAP as the reference value, and prereperfusion and postreperfusion SAPs as measured values. Univariable and multivariable logistic regression analyses were performed using 6 PM parameters and 36 traditional SAP-derived parameters to predict in-hospital mortality. In-hospital mortality was 3.9% (22/569 cases). Prereperfusion MDAPE and postreperfusion wobble were the only significant SAP-derived predictors of in-hospital mortality. The area under receiver operating characteristic curve of prediction model was 0.769 (95% confidence interval 0.732–0.803, P < 0.001; sensitivity = 55%, specificity = 94%). Severe hypotension during liver transplantation is concealed by proactive vasopressor treatment thus traditional measures of hypotension generally fail to detect the masked hypotension in retrospective analysis. PM analysis of intraoperative SAP including prereperfusion MDAPE and postreperfusion wobble is most likely to detect treated and therefore concealed hypotension, and was able to independently and quantitatively predict in-hospital mortality after liver transplantation with high diagnostic specificity.