PMID- 37604748 OWN - NLM STAT- MEDLINE DCOM- 20231127 LR - 20231128 IS - 1879-1883 (Electronic) IS - 0002-9610 (Linking) VI - 226 IP - 6 DP - 2023 Dec TI - Early predictors of prolonged intensive care utilization following liver transplantation. PG - 829-834 LID - S0002-9610(23)00306-9 [pii] LID - 10.1016/j.amjsurg.2023.06.032 [doi] AB - INTRODUCTION: Creatinine, bilirubin, and fibrinolysis resistance are associated with multi-organ dysfunction and likely risk factors for prolonged intensive care unit (pICU) stay following liver transplantation (LT). We hypothesize postoperative day-1 (POD-1) labs will predict pICU. METHODS: LT recipients had clinical laboratories and viscoelastic testing with tissue plasminogen activator thrombelastography (tPA TEG) to quantify fibrinolysis resistance (LY30) on POD-1. pICU was defined as one week or longer in the ICU. Logistic regression was used to identify the relationship between POD-1 labs and pICU. RESULTS: Of 304 patients, 50% went to the ICU, with 15% experiencing pICU. Elevated creatinine (OR 6.6, P ​< ​0.001) and low tPA TEG LY30 (OR 3.7, P ​= ​0.004) were independent predictors of pICU after controlling for other risk factors. A 9-fold increase in the rate of 90-day graft loss (19% vs 2% p ​< ​0.001) was observed patients who had these risk factors for pICU. CONCLUSION: Elevated creatine and fibrinolysis resistance are associated with pICU and poor outcomes following LT. CI - Copyright (c) 2023. Published by Elsevier Inc. FAU - Moore, Hunter B AU - Moore HB AD - Department of Surgery, Division of Transplant Surgery, University of Colorado, USA; Colorado Center for Transplantation Care, Research, and Education, Aurora, CO, USA; Department of Surgery, Division of Transplant Surgery, Children's Hospital Colorado, USA. Electronic address: hunter.moore@cuanschutz.edu. FAU - LaRiviere, Wells AU - LaRiviere W AD - Department of Surgery, Division of Transplant Surgery, University of Colorado, USA. FAU - Rodriguez, Ivan AU - Rodriguez I AD - Department of Surgery, Division of Transplant Surgery, University of Colorado, USA; Department of Surgery, Division of Transplant Surgery, Children's Hospital Colorado, USA. FAU - Brown, Kristen AU - Brown K AD - Department of Surgery, Division of Transplant Surgery, University of Colorado, USA; Department of Surgery, Division of Transplant Surgery, Children's Hospital Colorado, USA. FAU - Hadley, Kyndall AU - Hadley K AD - Department of Surgery, Division of Transplant Surgery, University of Colorado, USA; Department of Surgery, Division of Transplant Surgery, Children's Hospital Colorado, USA. FAU - Pomposelli, James J AU - Pomposelli JJ AD - Department of Surgery, Division of Transplant Surgery, University of Colorado, USA; Department of Surgery, Division of Transplant Surgery, Children's Hospital Colorado, USA. FAU - Adams, Megan A AU - Adams MA AD - Department of Surgery, Division of Transplant Surgery, University of Colorado, USA; Colorado Center for Transplantation Care, Research, and Education, Aurora, CO, USA; Department of Surgery, Division of Transplant Surgery, Children's Hospital Colorado, USA. FAU - Wachs, Michael E AU - Wachs ME AD - Department of Surgery, Division of Transplant Surgery, University of Colorado, USA; Colorado Center for Transplantation Care, Research, and Education, Aurora, CO, USA; Department of Surgery, Division of Transplant Surgery, Children's Hospital Colorado, USA. FAU - Conzen, Kendra D AU - Conzen KD AD - Department of Surgery, Division of Transplant Surgery, University of Colorado, USA; Department of Surgery, Division of Transplant Surgery, Children's Hospital Colorado, USA. FAU - Kennealey, Peter T AU - Kennealey PT AD - Department of Surgery, Division of Transplant Surgery, University of Colorado, USA; Department of Surgery, Division of Transplant Surgery, Children's Hospital Colorado, USA. FAU - Kaplan, Bruce AU - Kaplan B AD - Department of Surgery, Division of Transplant Surgery, University of Colorado, USA; Department of Surgery, Division of Transplant Surgery, Children's Hospital Colorado, USA. FAU - Pomfret, Elizabeth A AU - Pomfret EA AD - Department of Surgery, Division of Transplant Surgery, University of Colorado, USA; Department of Surgery, Division of Transplant Surgery, Children's Hospital Colorado, USA. FAU - Nydam, Trevor L AU - Nydam TL AD - Department of Surgery, Division of Transplant Surgery, University of Colorado, USA; Department of Surgery, Division of Transplant Surgery, Children's Hospital Colorado, USA. LA - eng PT - Journal Article DEP - 20230713 PL - United States TA - Am J Surg JT - American journal of surgery JID - 0370473 RN - EC 3.4.21.68 (Tissue Plasminogen Activator) RN - AYI8EX34EU (Creatinine) SB - IM MH - Humans MH - *Tissue Plasminogen Activator MH - *Liver Transplantation MH - Creatinine MH - Fibrinolysis MH - Critical Care OTO - NOTNLM OT - Critical care OT - Fibrinolysis OT - Graft failure OT - Liver transplant OT - Renal failure COIS- Declaration of competing interest Hunter Moore has patent issued with the tPA TEG that is licensed through the University of Colorado. This intellectual property is owned the University of Colorado. Haemonetics provided reagents at a discounted price, but was not involved with data analysis, interpretation, or any contribution to this manuscript. EDAT- 2023/08/22 00:41 MHDA- 2023/11/27 12:43 CRDT- 2023/08/21 22:01 PHST- 2023/03/22 00:00 [received] PHST- 2023/06/21 00:00 [revised] PHST- 2023/06/26 00:00 [accepted] PHST- 2023/11/27 12:43 [medline] PHST- 2023/08/22 00:41 [pubmed] PHST- 2023/08/21 22:01 [entrez] AID - S0002-9610(23)00306-9 [pii] AID - 10.1016/j.amjsurg.2023.06.032 [doi] PST - ppublish SO - Am J Surg. 2023 Dec;226(6):829-834. doi: 10.1016/j.amjsurg.2023.06.032. Epub 2023 Jul 13.