Blood loss and ICG clearance as best prognostic markers of post-hepatectomy liver failure.
OBJECTIVE
Hepatic failure after hepatic resection is a lethal complication. Various factors affecting the occurrence of hepatic failure were examined.


METHODS
The subjects were 315 patients who underwent hepatic resection for hepatocellular carcinoma during the 11-year period between 1985 and 1995. Univariate analyses of 14 variables were performed among living and dead patients after hepatic resection. With the significant prognostic variables obtained in the multivariate analysis, the predicted probability of death (PPD) was calculated for each patient.


RESULTS
There were 291 survivors and 24 patients with post-operative liver failure. Among the factors showing statistical or near significance in the univariate analysis, KICG and blood loss were disclosed to be factors independently correlating with survival. PPD was calculated for each patient according to the following equation: PPD = 1/Exp(1.6766 - 0.0004394 x blood loss + 16.69 x KICG) + 1. Assessing the goodness-of-fit model by Hosmer-Lemeshow test indicated the model seemed to fit quite well.


CONCLUSIONS
Minimizing the blood loss during hepatic resection is important to avoid post-operative liver failure. Careful hemostatic procedure is necessary for patients with unexpected massive blood loss during hepatic resection so as to prevent post-operative bleeding.
Nonami
T
T
Department of Surgery II, Nagoya University School of Medicine, Japan.
Nakao
A
A
Kurokawa
T
T
Inagaki
H
H
Matsushita
Y
Y
Sakamoto
J
J
Takagi
H
H
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical / Q000401:mortality / Q000503:physiopathology*; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000601:surgery*; D005260:Female; D006498:Hepatectomy; D006801:Humans; D007208:Indocyanine Green; D017093:Liver Failure / Q000175:diagnosis* / Q000401:mortality; D008113:Liver Neoplasms / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis* / Q000401:mortality; D011379:Prognosis; D015996:Survival Rate
D007208:Indocyanine Green