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Early Predictor of Mortality due to Irreversible Posthepatectomy Liver Failure in Patients with Hepatocellular Carcinoma

Authors
 Sung Hoon Kim  ;  Dae Ryong Kang  ;  Jae Gil Lee  ;  Do Young Kim  ;  Sang Hoon Ahn  ;  Kwang-Hyub Han  ;  Chae Yoon Chon  ;  Kyung Sik Kim 
Citation
 WORLD JOURNAL OF SURGERY, Vol.37(5) : 1028-1033, 2013 
Journal Title
 WORLD JOURNAL OF SURGERY 
ISSN
 0364-2313 
Issue Date
2013
MeSH
Adult ; Aged ; Bilirubin/blood ; Biomarkers/blood ; Carcinoma, Hepatocellular/surgery* ; Decision Support Techniques* ; Female ; Hepatectomy*/mortality ; Humans ; International Normalized Ratio ; Liver Failure/blood ; Liver Failure/diagnosis ; Liver Failure/etiology ; Liver Failure/mortality* ; Liver Neoplasms/surgery* ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Odds Ratio ; Postoperative Complications/blood ; Postoperative Complications/diagnosis ; Postoperative Complications/mortality* ; Predictive Value of Tests ; Prothrombin Time ; ROC Curve ; Retrospective Studies ; Treatment Outcome
Keywords
Bilirubin ; Liver Transplantation ; Liver Resection ; Positive Predictive Value ; Prothrombin Time
Abstract
BACKGROUND: Although mortality after liver resection has declined, posthepatectomy liver failure (PHLF) remains a major cause of operative mortality. To date there is not consensus on a definition for PHLF. However, there have been many efforts to define PHLF causing operative mortality. In the present study we sought to identify early predictors of death from irreversible PHLF. MATERIALS AND METHODS: We retrospectively analyzed the medical records of 359 patients with hepatocellular carcinoma who underwent liver resection between March 2000 and December 2010. Various biochemical parameters from postoperative days (POD) 1, 3, 5, and 7 were analyzed and compared with the "50-50" criterion. RESULTS: Operative mortality was 4.7 %. Prothrombin time (PT) <65 % and bilirubin ≥ 38 μmol/L on POD 5 showed the only significant difference as compared with "50-50" criterion. The new combination of bilirubin level and the international normalized ratio showed higher sensitivity, area under the curve, as well as similar accuracy (sensitivity 78.6 vs. 28.6 %; p = 0.002; area under the curve 0.8402 vs. 0.6396; p = 0.00176; accuracy 88.6 vs. 93.4 %; p = 0.090). Multivariate analysis revealed the combination of PT <65 % and bilirubin ≥ 38 μmol/L on POD 5 to be the only independent predictive factor of mortality (odds ratio, 82.29; 95 % confidence interval 8.69-779.64; p < 0.001). CONCLUSIONS: In patients with chronic liver disease who will undergo liver resection the combination of PT <65 % and bilirubin ≥ 38 μmol/L on POD 5 may be a more sensitive predictor than the "50-50" criterion of mortality from PHLF. Although it needs to validated by prospective study, this measure may be applied to select patients receiving artificial liver supports or liver transplantation.
Full Text
http://link.springer.com/article/10.1007%2Fs00268-013-1959-z
DOI
10.1007/s00268-013-1959-z
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Kyung Sik(김경식) ORCID logo https://orcid.org/0000-0001-9498-284X
Kim, Do Young(김도영)
Ahn, Sang Hoon(안상훈) ORCID logo https://orcid.org/0000-0002-3629-4624
Lee, Jae Gil(이재길) ORCID logo https://orcid.org/0000-0002-1148-8035
Chon, Chae Yoon(전재윤)
Han, Kwang-Hyub(한광협) ORCID logo https://orcid.org/0000-0003-3960-6539
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/86625
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