Haque et al reported a score which can help to identify a patient who may not need to be admitted to the intensive care unit (ICU) after a liver transplant. This is based on the fast-track score of Bulatao. The authors are from the University of Toronto.
Patient selection: liver transplant
Fast-tracking was postoperative care in the PACU without ICU admission.
Differences from the original fast-track score:
(1) MELD score: additional levels recognized (12.01 to 16, 16.01 to 21, > 21) with points 2,2,1,0 from 1,0,0,0.
(2) transfusion: changed from mL to units with unit being 288-300 mL, with lowest volume graded from 4 to 3 points
(3) vasopressor in the last hour of surgery: graded 1 vs 2 points
Parameters:
(1) age at transplant in years
(2) body mass index (BMI) in kg per square meter
(3) sex
(4) MELD score
(5) pretransplant length of stay in days
(6) transplant number
(7) packed red blood cells transfused in units
(8) operative time in minutes
(9) vasopressor during last hour of surgery
|
Parameter
|
Finding
|
Points
|
|
age at transplant
|
<= 65 years
|
1
|
|
|
> 65 years
|
0
|
|
BMI
|
<= 30 kg per sq m
|
1
|
|
|
> 30 kg per sq m
|
0
|
|
sex
|
female
|
0
|
|
|
male
|
1
|
|
MELD
|
<= 12
|
2
|
|
|
12.01 to 16
|
2
|
|
|
16.01 to 21
|
1
|
|
|
> 21
|
0
|
|
length of stay
|
0 days
|
1
|
|
|
> 0 days
|
0
|
|
transplant number
|
first
|
1
|
|
|
second or more
|
0
|
|
PRBC in mL
|
<= 5 units
|
3
|
|
|
5.01 to 9 units
|
3
|
|
|
9.01 to 14 units
|
2
|
|
|
> 14 units
|
0
|
|
operative time
|
<= 330 minutes
|
1
|
|
|
> 330 minutes
|
0
|
|
vasopressor last hour
|
no
|
1
|
|
|
yes
|
0
|
total score =
= SUM(points for all of the parameters)
Interpretation:
• miinimum score: 0
• maximum score: 12 (13 for the original score)
• The higher the score the greater the chances of fast-track success.
• A score >= 9 had the maximum Youden index with sensitivity 0.75 and specificity 0.61.
Perforamance:
• The area under the ROC curve was 0.83 for internal and 0.71 for external validation cohorts.
