Study On Rapid Preoperative Screening And Postoperative Recovery Of Patients With HBV Complicated With HPS

Part1 Rapid screening of patients with HPS in HBV induced liver disease based on machine learning algorithmBackground Hepatitis B virus(HBV)infection is the main cause of liver disease in China,and some of them may have hepatopulmonary syndrome(HPS),which is characterized by the intrapulmonary vascular dilation(IPVD).It significantly increases the incidence of perioperative complications and mortality in patients.However,HPS diagnosis still relies on contrast-enhanced echocardiography(CEE)and arterial blood gas(ABG)examination,screening methods for it from cirrhotic patients was not effective enough.We aimed to develop a simple and quick method to screening patients’ presence of IPVD using non-invasive and easily available variables by machine learning(ML)algorithms.Methods Cirrhotic patients in our hospital were enrolled.All eligible patients underwent CEE,ABG analysis and physical examination.This study has been approved by the Ethics Committee of our hospital.We developed a two-step model based on three ML algorithms,namely Adaptive Boosting(Ada Boost),Gradient Boosting Decision Tree(GBDT)and e Xtreme Gradient Boosting(Xgboost).The in-put of the first step(NI model)were non-invasive variables,and those of the second step(NIBG model)were combination of non-invasive variables and ABG.Model performances were determined by area under curve of Receiver Operating Characteristics(AUCROCs),precision,recall,F1-score and accuracy.Similarly,we also recruited hepatocellular carcinoma(HCC)patients who would undergo elective surgery.As before,they underwent data collection,CEE and ABG tests.We plan to establish a screening method for patients with HCC complicated with HPS based on ML algorithm.However,the ML part has not been carried out due to the limited time for graduate students.We will continue to complete this part in the future.Results Finally 193 cirrhotic patients were analyzed.The AUCROCs of NI and NIBG models were 0.850(0.738-0.962)and 0.867(0.760-0.973),and of which the accuracy was both 87.2%.The recall of NI and NIBG model for negative and positive cases were both0.867(0.760-0.973)and 0.875(0.771-0.979),similarly of which the precision for negative and positive cases were both 0.813(0.690-0.935)and 0.913(0.825-1.000).Conclusion We developed a two-step model based on ML using non-invasive variables and ABG results to screening presence of IPVD from cirrhotic patients,which may partly solve the problem of limited access to CEE and ABG on large amounts of cirrhotic patients.Part2 Study on the effect of combined HPS on postoperative recovery of HBV-HCC patientsBackground The mortality of HCC was high in China,in which was mostly associated with HBV cirrhosis.HPS is a severe pulmonary complication of advanced liver disease,which significantly increases the perioperative mortality and decreases patient quality of life.This study attempted to investigate the impact of HPS on post-operative recovery in hepatitis B virus-induced hepatocellular carcinoma(HBV-HCC)patients.Methods HBV-HCC patients undergoing primary curative hepatectomy for HCC in our hospital were diagnosed with HPS by CEE and ABG analysis.Patients were divided into HPS,IPVD(patients with positive CEE results and normal oxygenation)and control(patients with negative CEE results)groups.This study has been approved by the Ethics Committee of our hospital.Baseline information,peri-operative clinical data,and post-operative pulmonary complications(PPCs)were compared among all groups.Cytokines in patient serums from each group(n=8)were also assessed.Results Eighty-seven patients undergoing hepatectomy from October 2019 to January 2020 were analysed.The average time in the post-anaesthesia care unit(112.10±38.57 min)and oxygen absorption time after extubation(34.0(14.5-54.5)min)in the HPS group was longer than in IPVD(81.81±26.18 min and 16.0(12.3-24.0)min)and control(93.70±34.06 min and 20.5(13.8-37.0)min)groups.However,There were no significant differences in oxygen absorption time after extubation between HPS and control groups.The incidence of PPCs,especially bi-lateral pleural effusions in the HPS group(61.9%),was higher than in IPVD(12.5%)and control(30.0%)groups.Increased serum levels of growth-regulated oncogene(GRO),monocyte chemoattractant protein(MCP-1),soluble CD40 ligand(Scd40L)and interleukin 8(IL-8)might be related to delayed recovery in HPS patients.Conclusions HPS patients with HBV-HCC suffer delayed post-operative recovery and are at higher risk for PPCs,especially bi-lateral pleural effusions,which might be associated with changes in certain cytokines.