Cargando…
Epidemiology and Prognostic Significance of Rapid Response System Activation in Patients Undergoing Liver Transplantation
Patients undergoing liver transplantation have a high risk of perioperative clinical deterioration. The Rapid Response System is an intensive care unit-based approach for the early recognition and management of hospitalized patients identified as high-risk for clinical deterioration by a medical eme...
Autores principales: | , , , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2021
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8658097/ https://www.ncbi.nlm.nih.gov/pubmed/34884382 http://dx.doi.org/10.3390/jcm10235680 |
_version_ | 1784612649501196288 |
---|---|
author | Robertson, Marcus Lim, Andy K. H. Bloom, Ashley Chung, William Tsoi, Andrew Cannan, Elise Johnstone, Ben Huynh, Andrew O’Halloran, Tessa Gow, Paul Angus, Peter Jones, Daryl |
author_facet | Robertson, Marcus Lim, Andy K. H. Bloom, Ashley Chung, William Tsoi, Andrew Cannan, Elise Johnstone, Ben Huynh, Andrew O’Halloran, Tessa Gow, Paul Angus, Peter Jones, Daryl |
author_sort | Robertson, Marcus |
collection | PubMed |
description | Patients undergoing liver transplantation have a high risk of perioperative clinical deterioration. The Rapid Response System is an intensive care unit-based approach for the early recognition and management of hospitalized patients identified as high-risk for clinical deterioration by a medical emergency team (MET). The etiology and prognostic significance of clinical deterioration events is poorly understood in liver transplant patients. We conducted a cohort study of 381 consecutive adult liver transplant recipients from a prospectively collected transplant database (2011–2017). Medical records identified patients who received MET activation pre- and post-transplantation. MET activation was recorded in 131 (34%) patients, with 266 MET activations in total. The commonest triggers for MET activation were tachypnea and hypotension pre-transplantation, and tachycardia post-transplantation. In multivariable analysis, female sex, increasing Model for End-Stage Liver Disease score and hepatorenal syndrome were independently associated with MET activation. The unplanned intensive care unit admission rate following MET activation was 24.1%. Inpatient mortality was 4.2% and did not differ by MET activation status; however, patients requiring MET activation had significantly longer intensive care unit and hospital length of stay and were more likely to require inpatient rehabilitation. In conclusion, liver transplant patients with perioperative complications requiring MET activation represent a high-risk group with increased morbidity and length of stay. |
format | Online Article Text |
id | pubmed-8658097 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-86580972021-12-10 Epidemiology and Prognostic Significance of Rapid Response System Activation in Patients Undergoing Liver Transplantation Robertson, Marcus Lim, Andy K. H. Bloom, Ashley Chung, William Tsoi, Andrew Cannan, Elise Johnstone, Ben Huynh, Andrew O’Halloran, Tessa Gow, Paul Angus, Peter Jones, Daryl J Clin Med Article Patients undergoing liver transplantation have a high risk of perioperative clinical deterioration. The Rapid Response System is an intensive care unit-based approach for the early recognition and management of hospitalized patients identified as high-risk for clinical deterioration by a medical emergency team (MET). The etiology and prognostic significance of clinical deterioration events is poorly understood in liver transplant patients. We conducted a cohort study of 381 consecutive adult liver transplant recipients from a prospectively collected transplant database (2011–2017). Medical records identified patients who received MET activation pre- and post-transplantation. MET activation was recorded in 131 (34%) patients, with 266 MET activations in total. The commonest triggers for MET activation were tachypnea and hypotension pre-transplantation, and tachycardia post-transplantation. In multivariable analysis, female sex, increasing Model for End-Stage Liver Disease score and hepatorenal syndrome were independently associated with MET activation. The unplanned intensive care unit admission rate following MET activation was 24.1%. Inpatient mortality was 4.2% and did not differ by MET activation status; however, patients requiring MET activation had significantly longer intensive care unit and hospital length of stay and were more likely to require inpatient rehabilitation. In conclusion, liver transplant patients with perioperative complications requiring MET activation represent a high-risk group with increased morbidity and length of stay. MDPI 2021-12-01 /pmc/articles/PMC8658097/ /pubmed/34884382 http://dx.doi.org/10.3390/jcm10235680 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Robertson, Marcus Lim, Andy K. H. Bloom, Ashley Chung, William Tsoi, Andrew Cannan, Elise Johnstone, Ben Huynh, Andrew O’Halloran, Tessa Gow, Paul Angus, Peter Jones, Daryl Epidemiology and Prognostic Significance of Rapid Response System Activation in Patients Undergoing Liver Transplantation |
title | Epidemiology and Prognostic Significance of Rapid Response System Activation in Patients Undergoing Liver Transplantation |
title_full | Epidemiology and Prognostic Significance of Rapid Response System Activation in Patients Undergoing Liver Transplantation |
title_fullStr | Epidemiology and Prognostic Significance of Rapid Response System Activation in Patients Undergoing Liver Transplantation |
title_full_unstemmed | Epidemiology and Prognostic Significance of Rapid Response System Activation in Patients Undergoing Liver Transplantation |
title_short | Epidemiology and Prognostic Significance of Rapid Response System Activation in Patients Undergoing Liver Transplantation |
title_sort | epidemiology and prognostic significance of rapid response system activation in patients undergoing liver transplantation |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8658097/ https://www.ncbi.nlm.nih.gov/pubmed/34884382 http://dx.doi.org/10.3390/jcm10235680 |
work_keys_str_mv | AT robertsonmarcus epidemiologyandprognosticsignificanceofrapidresponsesystemactivationinpatientsundergoinglivertransplantation AT limandykh epidemiologyandprognosticsignificanceofrapidresponsesystemactivationinpatientsundergoinglivertransplantation AT bloomashley epidemiologyandprognosticsignificanceofrapidresponsesystemactivationinpatientsundergoinglivertransplantation AT chungwilliam epidemiologyandprognosticsignificanceofrapidresponsesystemactivationinpatientsundergoinglivertransplantation AT tsoiandrew epidemiologyandprognosticsignificanceofrapidresponsesystemactivationinpatientsundergoinglivertransplantation AT cannanelise epidemiologyandprognosticsignificanceofrapidresponsesystemactivationinpatientsundergoinglivertransplantation AT johnstoneben epidemiologyandprognosticsignificanceofrapidresponsesystemactivationinpatientsundergoinglivertransplantation AT huynhandrew epidemiologyandprognosticsignificanceofrapidresponsesystemactivationinpatientsundergoinglivertransplantation AT ohallorantessa epidemiologyandprognosticsignificanceofrapidresponsesystemactivationinpatientsundergoinglivertransplantation AT gowpaul epidemiologyandprognosticsignificanceofrapidresponsesystemactivationinpatientsundergoinglivertransplantation AT anguspeter epidemiologyandprognosticsignificanceofrapidresponsesystemactivationinpatientsundergoinglivertransplantation AT jonesdaryl epidemiologyandprognosticsignificanceofrapidresponsesystemactivationinpatientsundergoinglivertransplantation |