Early predictor of mortality due to irreversible posthepatectomy liver failure in patients with hepatocellular carcinoma

Sung Hoon Kim, Dae Ryong Kang, Jae Gil Lee, Do Young Kim, Sang Hoon Ahn, Kwang Hyub Han, Chae Yoon Chon, Kyung Sik Kim

Research output: Contribution to journalArticle

10 Citations (Scopus)

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 C38 lmol/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 C38 lmol/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 C38 lmol/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.

Original languageEnglish
Pages (from-to)1028-1033
Number of pages6
JournalWorld Journal of Surgery
Volume37
Issue number5
DOIs
Publication statusPublished - 2013 May 1

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Liver Failure
Hepatocellular Carcinoma
Bilirubin
Mortality
Prothrombin Time
Area Under Curve
Liver
Artificial Liver
International Normalized Ratio
Liver Transplantation
Medical Records
Liver Diseases
Chronic Disease
Multivariate Analysis
Odds Ratio
Prospective Studies
Confidence Intervals

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

@article{1f1f96fcdf214343886a66672bbceb59,
title = "Early predictor of mortality due to irreversible posthepatectomy liver failure in patients with hepatocellular carcinoma",
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 C38 lmol/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 C38 lmol/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 C38 lmol/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.",
author = "Kim, {Sung Hoon} and Kang, {Dae Ryong} and Lee, {Jae Gil} and Kim, {Do Young} and Ahn, {Sang Hoon} and Han, {Kwang Hyub} and Chon, {Chae Yoon} and Kim, {Kyung Sik}",
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Early predictor of mortality due to irreversible posthepatectomy liver failure in patients with hepatocellular carcinoma. / Kim, Sung Hoon; Kang, Dae Ryong; Lee, Jae Gil; Kim, Do Young; Ahn, Sang Hoon; Han, Kwang Hyub; Chon, Chae Yoon; Kim, Kyung Sik.

In: World Journal of Surgery, Vol. 37, No. 5, 01.05.2013, p. 1028-1033.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Early predictor of mortality due to irreversible posthepatectomy liver failure in patients with hepatocellular carcinoma

AU - Kim, Sung Hoon

AU - Kang, Dae Ryong

AU - Lee, Jae Gil

AU - Kim, Do Young

AU - Ahn, Sang Hoon

AU - Han, Kwang Hyub

AU - Chon, Chae Yoon

AU - Kim, Kyung Sik

PY - 2013/5/1

Y1 - 2013/5/1

N2 - 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 C38 lmol/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 C38 lmol/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 C38 lmol/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.

AB - 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 C38 lmol/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 C38 lmol/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 C38 lmol/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.

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