Risk Factors for Reintubation Related to Non-Airway Failure After Liver Transplantation in Intensive Care Unit: Observational Study

Abstract

The aim of this observational study was to evaluate the risk factors and predictive indexes of reintubation in patients after liver transplantation in the intensive care unit of a university hospital. The time at the intensive care unit, time on mechanical ventilation, use of noninvasive ventilation, ventilator-associated pneumonia, mortality, sequential organ failure assessment scores (SOFA), simplified acute physiology score (SAPS3), model for end-stage liver disease (MELD), Child-Pugh (CHILD), Acute Physiology and Chronic Health Disease Classification System II (APACHE II), and balance of risk score (BAR) were correlated with reintubation. The following tests were used for the statistical analysis: Kolmogorov-Smirnov, χ2, Student’s t-test, and regression analysis and receiver operating characteristic (ROC) curve. Two hundred and thirtyseven individuals were analyzed. Among them, 38 (16%) were reintubated. The comparative analysis was performed between reintubated and nonreintubated individuals. The variables analyzed – ventilator associated pneumonia, death, mechanical ventilation time, intensive care unit time, noninvasive ventilation use, MELD score, SAPS 3, BAR, and SOFA third days – after liver transplantation were significantly different (p < 0.001). In the multivariate regression analysis, the predictors of reintubation after liver transplantation were ventilator associated pneumonia (odds ratio – OR = 10.6; 95% confidence interval – 95%CI 1.04-108.3; p = 0.04) and BAR (OR = 1.18; 95%CI 1.02-1.36; p = 0.02). The highest ROC curves were SOFA third day, MELD, SAPS 3 and BAR scores through the intersections of the sensitivity and specificity curves > 0.70. High values of the BAR score were considered risk factors for reintubation in this study. SOFA third day showed moderate discriminatory power in predicting reintubation after liver transplantation.