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World J Gastroenterol. 2014 Jan 7;20(1):274-81. doi: 10.3748/wjg.v20.i1.274.

An accurate predictor of liver failure and death after hepatectomy: a single institution's experience with 478 consecutive cases.

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  • 1Zheng-Gui Du, Yong-Gang Wei, Ke-Fei Chen, Bo Li, Department of Liver Surgery, Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.

Abstract

AIM:

To establish a reliable definition of postoperative liver failure (PLF) and allow the prediction of outcomes after hepatectomy.

METHODS:

The clinical data of 478 consecutive patients who underwent hepatectomy were retrospectively analyzed. The examined prognostic factors included the ratio of total bilirubin (TBIL) on postoperative day (POD) X to TBIL on POD 1 (TBIL-r1) and the ratio of the international normalized ratio (INR) on POD X to the INR on POD 1 (INR-r1) for PODs 3, 5 and 7. Student's t test, the χ(2) test, logistic regression, survival analysis and receiver operating curve analysis were used to evaluate risk factors and establish the definition of postoperative liver failure (PLF).

RESULTS:

Fourteen patients (2.9%) died of liver failure within 3 mo of surgery. Significant differences were found between patients who died of liver failure and the remaining patients in terms of TBIL-r1 and INR-r1 on PODs 3, 5 and 7. The combination of TBIL-r1 and INR-r1 on POD 5 showed strong predictive power for liver failure-related death (sensitivity 92.9% and specificity 90.1%). The hepatic damage score (HDs), which was derived from TBIL-r1 and INR-r1, was used to define the degree of metabolic functional impairment after resection as mild (HDs = 0), reversible hepatic "dysfunction" (HDs = 1) or fatal hepatic failure (HDs = 2). Furthermore, the indocyanine green retention rate at 15 min (ICG-R15) and the number of resected segments (RSs) were identified as independent predictors of the HDs. A linear relationship was found between ICG-R15 and RSs in the HDs = 2 group. The regression equation was: RSs = -0.168 × ICG-R15 + 5.625 (r (2) = 0.613, F = 14.257, P = 0.004).

CONCLUSION:

PLF can be defined by the HDs, which accurately predicts liver failure-related death after liver resection. Furthermore, the ICG-R15 and RSs can be used as selection criteria for hepatectomy.

KEYWORDS:

Hepatectomy; Hepatic dysfunction; Liver failure; Morbidity; Mortality

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