Justo et al reported a new index for predicting massive transfusion following liver transplantation. This can help to identify a patient who may require more aggressive management. The authors are from 12 de Octubre University Hospital and University Hospital Salamanca in Spain.
Patient selection: liver transplant recipient
Massive transfusion: >= 6 units in first 24 hours after the transplant
Parameters:
(1) serum creatinine in mg/dL
(2) hemoglobin in g/dL
(3) uncontrolled donor after cardiac death (uDCD)
(4) split liver transplant
(5) serum sodium in mmol/L
(6) platelet count per microliter
(7) INR
Parameter
Finding
Points
serum creatinine
<= 1 mg/dL
0
> 1 mg/dL
2
hemoglobin
>= 11.2 g/dL
0
< 11.2 g/dL
2
uncontrolled donor
no
0
yes
2
split liver transplant
no
0
yes
2
serum sodium
>= 137 mmol/L
0
< 137 mmol/L
1
platelet count
>= 76,000 per µL
0
< 76,000 per µL
1
INR
<= 1.42
0
> 1.42
1
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 11
• The higher the score the greater the risk of massive blood transfusion but not cuf-off seen.
Performance:
• The area under the ROC curve is 0.76.
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