Abstract | OBJECTIVE: 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.
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Authors | Joanna 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 |
Journal | HPB : 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 |
PMID | 24836954
(Publication Type: Journal Article)
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Copyright | © 2014 International Hepato-Pancreato-Biliary Association. |
Chemical References |
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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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