Establishment and validation of risk prediction model for prolonged mechanical ventilation after lung transplantation_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

WANG Dapeng ¹ , ZHU Jingsong ¹ , LI Xiaoshan ² , LIANG Chenglong ¹ , ZHOU Tao ¹ ,  XU Hongyang ¹

1. Department of Intensive Medicine. The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi People’s Hospital, Wuxi Medical Center, Nanjing Medical University, Wuxi, , Jiangsu 214023, P.R.China;
2. Department of Lung Transplantation Center. The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi People’s Hospital, Wuxi Medical Center, Nanjing Medical University, Wuxi, Jiangsu 214023, P.R.China;

Corresponding author：

XU Hongyang, Email: xhy1912@aliyun.com

Keywords：

Lung transplantation; prolonged mechanical ventilation; risk prediction models

DOI：

10.7507/1671-6205.202504036

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Objective Prolonged mechanical ventilation (PMV) is a prognostic marker for short-term adverse outcomes in patients after lung transplantation.The risk of prolonged mechanical ventilation after lung transplantation is still not clear. The study to identify the risk factors of prolonged mechanical ventilation (PMV) after lung transplantation.Methods This retrospective observational study recruited patients who underwent lung transplantation in Wuxi People’s Hospital from January 2020 to December 2022. Relevant information was collected from patients and donors, including recipient data (gender, age, BMI, blood type, comorbidities), donor data (age, BMI, time of endotracheal intubation, oxygenation index, history of smoking, and any comorbidity with multidrug-resistant bacterial infections), and surgical data (surgical mode, incision type, operation time, cold ischemia time of the donor lung, intraoperative bleeding, and ECMO support), and postoperative data (multi-resistant bacterial lung infection, multi-resistant bacterial bloodstream infection, and mean arterial pressure on postoperative admission to the monitoring unit). Patients with a duration of mechanical ventilation ≤72 hours were allocated to the non-prolonged mechanical ventilation group, and patients with a duration of mechanical ventilation>72 hours were allocated to the prolonged mechanical ventilation group. LASSO regression analysis was applied to screen risk factors., and a clinical prediction model for the risk of prolonged mechanical ventilation after lung.Results Patients who met the inclusion criteria were divided into the training set and the validation set. There were 307 cases in the training set group and 138 cases in the validation set group. The basic characteristics of the training set and the validation set were compared. There were statistically significant differences in the recipient’s BMI, donor’s gender, CRKP of the donor lung swab, whether the recipient had pulmonary infection before the operation, the type of transplantation, the cold ischemia time of the donor lung, whether ECMO was used during the operation, the duration of ECMO assistance, CRKP of sputum, and the CRE index of the recipient's anal test (P<0.05). 2. The results of the multivariate logistic regression model showed that female recipients, preoperative mechanical ventilation in recipients, preoperative pulmonary infection in recipients, intraoperative application of ECMO, and the detection of multi-drug resistant Acinetobacter baumannii, multi-drug resistant Klebsiella pneumoniae and maltoclomonas aeruginosa in postoperative sputum were independent risk factors for prolonged mechanical ventilation after lung transplantation. The AUC of the clinical prediction model in the training set and the validation set was 0.838 and 0.828 respectively, suggesting that the prediction model has good discrimination. In the decision curves of the training set and the validation set, the threshold probabilities of the curves in the range of 0.05-0.98 and 0.02-0.85 were higher than the two extreme lines, indicating that the model has certain clinical validity.Conclusions Female patients, Preoperative pulmonary infection, preoperative mechanical ventilation,blood type B, blood type O, application of ECMO assistance, multi-resistant Acinetobacter baumannii infection, multi-resistant Klebsiella pneumoniae infection, and multi-resistant Stenotrophomonas maltophilia infection are independent risk factors for PMV (prolonged mechanical ventilation) after lung transplantation.

1.	Gao P, Li C, Wu J, et al. Establishment of a risk prediction model for prolonged mechanical ventilation after lung transplantation: a retrospective cohort study. BMC Pulm Med, 2023, 23(1): 11.
2.	Swaminathan AC, Todd JL, Palmer SM. Advances in Human Lung Transplantation. Annu Rev Med, 2021, 72: 135-149.
3.	Di Nardo M, Tikkanen J, Husain S, et al. Postoperative Management of Lung Transplant Recipients in the Intensive Care Unit. Anesthesiology, 2022, 136(3): 482-499.
4.	Snell GI, Yusen RD, Weill D, et al. Report of the ISHLT Working Group on Primary Lung Graft Dysfunction, part I: Definition and grading-A 2016 Consensus Group statement of the International Society for Heart and Lung Transplantation. J Heart Lung Transplant, 2017, 36(10): 1097-1103.
5.	Carson SS. Outcomes of prolonged mechanical ventilation. Curr Opin Crit Care, 2006, 12(5): 405-411.
6.	Hadem J, Gottlieb J, Seifert D, et al. Prolonged Mechanical Ventilation After Lung Transplantation-A Single-Center Study. Am J Transplant, 2016, 16(5): 1579-1587.
7.	Hill AD, Fowler RA, Burns KE, Rose L, Pinto RL, Scales DC. Long-Term Outcomes and Health Care Utilization after Prolonged Mechanical Ventilation. Ann Am Thorac Soc, 2017, 14(3): 355-362.
8.	Jubran A, Grant BJB, Duffner LA, et al. Long-Term Outcome after Prolonged Mechanical Ventilation. A Long-Term Acute-Care Hospital Study. Am J Respir Crit Care Med, 2019, 199(12): 1508-1516.
9.	Raskin J, Vanstapel A, Verbeken EK, et al. Mortality after lung transplantation: a single-centre cohort analysis. Transpl Int, 2020, 33(2): 130-141.
10.	Schwarz S, Benazzo A, Dunkler D, et al. Ventilation parameters and early graft function in double lung transplantation. J Heart Lung Transplant, 2021, 40(1): 4-11.
11.	Hu L, Ayyat KS, Weingarten N, et al. Long-Term Weaning of Mechanical Ventilation After Lung Transplantation: Patient Characteristics and Impact on Surviva. J Heart Lung Transpl, 2022, 41(4S): S91-S91.
12.	Atchade E, Boughaba A, Dinh AT, et al. Prolonged mechanical ventilation after lung transplantation: risks factors and consequences on recipient outcome. Front Med (Lausanne), 2023, 10: 1160621.
13.	王大鹏, 李小杉, 轩晨昊, 等. 肺移植术后机械通气延长的危险因素分析. 器官移植. 2022, 13(6): 797-802.
14.	Schwer CI, Roth T, Gass M, et al. Risk Factors for Prolonged Mechanical Ventilation and Delayed Extubation Following Bimaxillary Orthognathic Surgery: A Single-Center Retrospective Cohort Study. J Clin Med, 2022, 11(13): 3829.
15.	Zhang C, Yang L, Shi S, Fang Z, Li J, Wang G. Risk Factors for Prolonged Mechanical Ventilation After Pulmonary Endarterectomy: 7 Years' Experience From an Experienced Hospital in China. Front Surg, 2021, 8: 679273.
16.	Wang A, An X, Xia VW. Female Gender of the Recipient Is Independently Associated With Prolonged Ventilation Time and Hospital Stay After Liver Transplantation. Transplant Proc, 2016, 48(1): 120-122.
17.	王文静, 李小杉, 钱婷, 等. 肺移植术后肺部感染的研究现状. 中国呼吸与危重监护杂志, 2022, 21(08): 550-555.
18.	卫栋, 范立, 班乐. 中国肺移植术后并发症诊疗和随访技术规范(2019版). 中华移植杂志(电子版), 2019, 13(2): 99-108.
19.	Konishi Y, Miyoshi K, Kurosaki T, et al. Airway bacteria of the recipient but not the donor are relevant to post-lung transplant pneumonia. Gen Thorac Cardiovasc Surg, 2020, 68(8): 833-840.
20.	Akinnusi ME, Pineda LA, El Solh AA. Effect of obesity on intensive care morbidity and mortality: a meta-analysis. Crit Care Med, 2008, 36(1): 151-158.
21.	Lederer DJ, Wilt JS, D'Ovidio F, et al. Obesity and underweight are associated with an increased risk of death after lung transplantation. Am J Respir Crit Care Med, 2009, 180(9): 887-895.
22.	Madill J, Gutierrez C, Grossman J, et al. Nutritional assessment of the lung transplant patient: body mass index as a predictor of 90-day mortality following transplantation. J Heart Lung Transplant, 2001, 20(3): 288-296.
23.	Akimova T, Zhang T, Christensen LM, et al. Obesity-related IL-18 Impairs T-Regulatory Cell Function and Promotes Lung Ischemia-Reperfusion Injury. Am J Respir Crit Care Med, 2021, 204(9): 1060-1074.
24.	Diamond JM, Lee JC, Kawut SM, et al. Clinical risk factors for primary graft dysfunction after lung transplantation. Am J Respir Crit Care Med, 2013, 187(5): 527-534.
25.	Palma G, Sorice GP, Genchi VA, et al. Adipose Tissue Inflammation and Pulmonary Dysfunction in Obesity. Int J Mol Sci, 2022, 23(13): 7349.

1. Gao P, Li C, Wu J, et al. Establishment of a risk prediction model for prolonged mechanical ventilation after lung transplantation: a retrospective cohort study. BMC Pulm Med, 2023, 23(1): 11.
2. Swaminathan AC, Todd JL, Palmer SM. Advances in Human Lung Transplantation. Annu Rev Med, 2021, 72: 135-149.
3. Di Nardo M, Tikkanen J, Husain S, et al. Postoperative Management of Lung Transplant Recipients in the Intensive Care Unit. Anesthesiology, 2022, 136(3): 482-499.
4. Snell GI, Yusen RD, Weill D, et al. Report of the ISHLT Working Group on Primary Lung Graft Dysfunction, part I: Definition and grading-A 2016 Consensus Group statement of the International Society for Heart and Lung Transplantation. J Heart Lung Transplant, 2017, 36(10): 1097-1103.
5. Carson SS. Outcomes of prolonged mechanical ventilation. Curr Opin Crit Care, 2006, 12(5): 405-411.
6. Hadem J, Gottlieb J, Seifert D, et al. Prolonged Mechanical Ventilation After Lung Transplantation-A Single-Center Study. Am J Transplant, 2016, 16(5): 1579-1587.
7. Hill AD, Fowler RA, Burns KE, Rose L, Pinto RL, Scales DC. Long-Term Outcomes and Health Care Utilization after Prolonged Mechanical Ventilation. Ann Am Thorac Soc, 2017, 14(3): 355-362.
8. Jubran A, Grant BJB, Duffner LA, et al. Long-Term Outcome after Prolonged Mechanical Ventilation. A Long-Term Acute-Care Hospital Study. Am J Respir Crit Care Med, 2019, 199(12): 1508-1516.
9. Raskin J, Vanstapel A, Verbeken EK, et al. Mortality after lung transplantation: a single-centre cohort analysis. Transpl Int, 2020, 33(2): 130-141.
10. Schwarz S, Benazzo A, Dunkler D, et al. Ventilation parameters and early graft function in double lung transplantation. J Heart Lung Transplant, 2021, 40(1): 4-11.
11. Hu L, Ayyat KS, Weingarten N, et al. Long-Term Weaning of Mechanical Ventilation After Lung Transplantation: Patient Characteristics and Impact on Surviva. J Heart Lung Transpl, 2022, 41(4S): S91-S91.
12. Atchade E, Boughaba A, Dinh AT, et al. Prolonged mechanical ventilation after lung transplantation: risks factors and consequences on recipient outcome. Front Med (Lausanne), 2023, 10: 1160621.
13. 王大鹏, 李小杉, 轩晨昊, 等. 肺移植术后机械通气延长的危险因素分析. 器官移植. 2022, 13(6): 797-802.
14. Schwer CI, Roth T, Gass M, et al. Risk Factors for Prolonged Mechanical Ventilation and Delayed Extubation Following Bimaxillary Orthognathic Surgery: A Single-Center Retrospective Cohort Study. J Clin Med, 2022, 11(13): 3829.
15. Zhang C, Yang L, Shi S, Fang Z, Li J, Wang G. Risk Factors for Prolonged Mechanical Ventilation After Pulmonary Endarterectomy: 7 Years' Experience From an Experienced Hospital in China. Front Surg, 2021, 8: 679273.
16. Wang A, An X, Xia VW. Female Gender of the Recipient Is Independently Associated With Prolonged Ventilation Time and Hospital Stay After Liver Transplantation. Transplant Proc, 2016, 48(1): 120-122.
17. 王文静, 李小杉, 钱婷, 等. 肺移植术后肺部感染的研究现状. 中国呼吸与危重监护杂志, 2022, 21(08): 550-555.
18. 卫栋, 范立, 班乐. 中国肺移植术后并发症诊疗和随访技术规范(2019版). 中华移植杂志(电子版), 2019, 13(2): 99-108.
19. Konishi Y, Miyoshi K, Kurosaki T, et al. Airway bacteria of the recipient but not the donor are relevant to post-lung transplant pneumonia. Gen Thorac Cardiovasc Surg, 2020, 68(8): 833-840.
20. Akinnusi ME, Pineda LA, El Solh AA. Effect of obesity on intensive care morbidity and mortality: a meta-analysis. Crit Care Med, 2008, 36(1): 151-158.
21. Lederer DJ, Wilt JS, D'Ovidio F, et al. Obesity and underweight are associated with an increased risk of death after lung transplantation. Am J Respir Crit Care Med, 2009, 180(9): 887-895.
22. Madill J, Gutierrez C, Grossman J, et al. Nutritional assessment of the lung transplant patient: body mass index as a predictor of 90-day mortality following transplantation. J Heart Lung Transplant, 2001, 20(3): 288-296.
23. Akimova T, Zhang T, Christensen LM, et al. Obesity-related IL-18 Impairs T-Regulatory Cell Function and Promotes Lung Ischemia-Reperfusion Injury. Am J Respir Crit Care Med, 2021, 204(9): 1060-1074.
24. Diamond JM, Lee JC, Kawut SM, et al. Clinical risk factors for primary graft dysfunction after lung transplantation. Am J Respir Crit Care Med, 2013, 187(5): 527-534.
25. Palma G, Sorice GP, Genchi VA, et al. Adipose Tissue Inflammation and Pulmonary Dysfunction in Obesity. Int J Mol Sci, 2022, 23(13): 7349.

Chinese Journal of Respiratory and Critical Care Medicine

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