肝移植手术中动脉血压波形具有反映受体疾病急性程度并预测短期预后的形态学变异性
Arterial blood pressure waveform in liver transplant surgery possesses variability of morphology reflecting recipients' acuity and predicting short term outcomes
AI总结：
研究提出DDMap算法量化肝移植手术中动脉血压波形形态学变异性，发现术前变异性反映患者疾病急性程度，新肝期变异性预测短期手术预后。
摘要：
背景：我们研究了动脉血压（ABP）波形形态学逐搏波动背后的临床信息。我们提出了Dynamical Diffusion Map算法（DDMap）来量化形态学变异性。其潜在生理机制可能是涉及调节心血管系统的各种生理机制之间复杂相互作用的代偿机制。由于肝移植手术包含不同阶段，我们研究了其在不同手术步骤中的临床行为。方法：我们的研究使用基于无监督流形学习的DDMap算法，获取形态学逐搏变异性的定量指标。我们检查了ABP形态学变异性与由终末期肝病模型（MELD）评分指示的疾病急性程度、术后实验室数据以及4种早期移植物衰竭（EAF）评分之间的相关性。结果：在85名入组患者中，术前阶段获得的形态学变异性与MELD-Na评分相关性最好。新肝期形态学变异性与EAF评分以及术后胆红素水平、国际标准化比值、天冬氨酸转氨酶水平和血小板计数相关。此外，形态学变异性与上述临床状况的关联性高于常见血压测量值及其血压变异性指数。结论：术前阶段获得的形态学变异性指示患者急性程度，而新肝期形态学变异性指示短期手术预后。
英文摘要：
Background: We investigated clinical information underneath the beat-to-beat fluctuation of the arterial blood pressure (ABP) waveform morphology. We proposed the Dynamical Diffusion Map algorithm (DDMap) to quantify the variability of morphology. The underlying physiology could be the compensatory mechanisms involving complex interactions between various physiological mechanisms to regulate the cardiovascular system. As a liver transplant surgery contains distinct periods, we investigated its clinical behavior in different surgical steps. Methods: Our study used DDmap algorithm, based on unsupervised manifold learning, to obtain a quantitative index for the beat-to-beat variability of morphology. We examined the correlation between the variability of ABP morphology and disease acuity as indicated by Model for End-Stage Liver Disease (MELD) scores, the postoperative laboratory data, and 4 early allograft failure (EAF) scores. Results: Among the 85 enrolled patients, the variability of morphology obtained during the presurgical phase was best correlated with MELD-Na scores. The neohepatic phase variability of morphology was associated with EAF scores as well as postoperative bilirubin levels, international normalized ratio, aspartate aminotransferase levels, and platelet count. Furthermore, variability of morphology presents more associations with the above clinical conditions than the common BP measures and their BP variability indices. Conclusions: The variability of morphology obtained during the presurgical phase is indicative of patient acuity, whereas those during the neohepatic phase are indicative of short-term surgical outcomes.
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