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Early identification of patients at increased risk for hepatic insufficiency, complications and mortality after major hepatectomy.

AbstractOBJECTIVE:
Total bilirubin (TB) of >7 mg/dl is an accepted definition of postoperative hepatic insufficiency (PHI) given its association with the occurrence of complications and mortality after hepatectomy. The aim of this study was to identify a surrogate marker for PHI early in the postoperative course.
METHODS:
A single-institution database of patients undergoing major hepatectomy (three or more segments) during 2000-2012 was retrospectively reviewed. Demographic, clinicopathologic and perioperative factors were assessed for their association with PHI, defined as postoperative TB of >7 mg/dl or new ascites. Secondary outcomes included complications, major complications (Clavien-Dindo Grades III-V) and 90-day mortality.
RESULTS:
A total of 607 patients undergoing major hepatectomy without bile duct reconstruction were identified. Postoperative hepatic insufficiency occurred in 60 (9.9%) patients. A postoperative day 3 (PoD 3) TB level of ≥3 mg/dl was the only early perioperative factor associated with the development of PHI on multivariate analysis [hazard ratio (HR) = 7.81, 95% confidence interval (CI) 3.74-16.31; P < 0.001]. A PoD 3 TB of ≥3 mg/dl was associated with increased risk for postoperative complications (75.7% versus 53.9%), major complications (45.6% versus 17.6%), and 90-day mortality (15.5% versus 2.3%). This association persisted on multivariate analysis for any complications (HR = 1.98, 95% CI 1.10-3.54; P = 0.022), major complications (HR = 3.18, 95% CI 1.90-5.32; P < 0.001), and 90-day mortality (HR = 8.11, 95% CI 3.00-21.92; P < 0.001).
CONCLUSIONS:
Total bilirubin of ≥3 mg/dl on PoD 3 after major hepatectomy is associated with PHI, increased complications, major complications and 90-day mortality. This marker may serve as an early postoperative predictor of hepatic insufficiency.
AuthorsJoanna W Etra, Malcolm H Squires 3rd, Sarah B Fisher, Daniel R Rutz, Benjamin M Martin, David A Kooby, Kenneth Cardona, Juan M Sarmiento, Charles A Staley 3rd, Shishir K Maithel, Maria C Russell
JournalHPB : the official journal of the International Hepato Pancreato Biliary Association (HPB (Oxford)) Vol. 16 Issue 10 Pg. 875-83 (Oct 2014) ISSN: 1477-2574 [Electronic] England
PMID24836954 (Publication Type: Journal Article)
Copyright© 2014 International Hepato-Pancreato-Biliary Association.
Chemical References
  • Biomarkers
  • Bilirubin
Topics
  • Adult
  • Aged
  • Aged, 80 and over
  • Bilirubin (blood)
  • Biomarkers (blood)
  • Chi-Square Distribution
  • Databases, Factual
  • Early Diagnosis
  • Female
  • Georgia
  • Hepatectomy (adverse effects, mortality)
  • Hepatic Insufficiency (blood, diagnosis, etiology, mortality)
  • Humans
  • Liver Regeneration
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Predictive Value of Tests
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • Time Factors
  • Treatment Outcome
  • Up-Regulation
  • Young Adult

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