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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...

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Autores principales: 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
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
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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.
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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
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