Platelets level variability during the first year after liver transplantation in the risk prediction model for recipients mortality.

INTRODUCTION AND OBJECTIVES: Many scoring systems in liver diseases use static values of liver function parameters. These parameters may change significantly in liver transplant (LTx) recipients over time due to various processes. The study was aimed at building a new model for survival prediction after LTx based on variability of selected parameters. MATERIALS AND METHODS: The study included 450 LTx recipients who survived a minimum one year after transplantation. We analyzed liver enzymes and hematology parameters static values and their variability during the first year after transplantation. Modeling patients' survival was performed using Cox regression. Various sets of parameters (both static and variability and trends values) were tested to predict survival in our study group. Models' performance was measured using the concordance index. RESULTS: The single predictors of the patients survival were the static values of AST with C-index 0.706 (0.5883-0.7494), ALT 0.6102 (0.4843-0.6857) and bilirubin 0.6224 (0.5537-0.6695). High prediction scores were observed for variability in creatinine 0.6023 (0.5409-0.6451), PLT 0.6350 (0.5491-0.7043), RBC 0.5689 (0.5065-0.6213) and WBC 0.6506 (0.5095-0.7124). Our best-fitted and proposed model for patients survival after LTx has C-index 0.8273 (IQR 0.7767-0.8649). The model uses the following indicators for mortality prediction: the static value of AST, variability measure of PLT and trend measures of WBC and PLT. CONCLUSIONS: Adding variability and trend measures increases predictive accuracy in modeling patients survival after LTx. We propose a high-accuracy survival model in which variability and trend of PLT measures in the first year after transplantation are strong predictors of long-term mortality.

[Respiratory tract burn injuries]. / Oparzenia dróg oddechowych.

Respiratory tract burns are one of the most serious injuries of human organism. They often accompany severe skin burns, increasing morbidity and mortality. Pathologic events happening in the lungs in the course of inhalation injury consist of: edema and necrosis of bronchial mucosa, increase of bronchial blood flow and vascular permeability, recruitment of inflammatory mediators, and obturation of bronchial tract with the casts composed of mucus, tissue debris, neutrophils and fibrin. The above mentioned processes lead to progressive disturbances of pulmonary gas exchange and tissue hypoxia. Introduction of standardized bronchoscopic procedures resulted in the possibility of early diagnosis and treatment of inhalation injuries. There are many treatment options, some of them combined with early and late complications, the optimal treatment protocol is still lacking. Early hyperbaric oxygen therapy is one of the most promising methods of treatment leading to decrease of mortality due to inhalation injury.