title: Risk factors for postoperative liver failure after hepatectomy for hepatocellular carcinoma.
abstract: OBJECTIVE
  Selection of patients for hepatectomy for hepatocellular carcinoma conventionally has been based upon Child-Pugh grading. However, postoperative liver failure after hepatectomy is a major cause of hospital mortality. A new predictor of postoperative liver failure is required. The objective of this study was to identify risk factors for postoperative liver failure after hepatectomy.
  
  
  METHODS
  Perioperative risk factors for liver failure after hepatectomy were analyzed in 112 patients with hepatocellular carcinoma Eight of these patients died of liver failure. Stepwise multivariate logistic regression was performed to investigate significant independent factors among 17 variables, including the serum alkaline phosphatase ratio (ALPR) on the first day after hepatectomy. ALPR was calculated as the postoperative ALP level divided by the ALP level before surgery.
  
  
  RESULTS
  Significant risk factors of postoperative liver failure were ALPR on postoperative day 1 (ALPR1), sex, operative blood loss, and operative procedure. As an indicator of liver failure, the diagnostic accuracy of the ALPR1 was 93.7% when the ALPR was less than 0.4 on the first postoperative day. The ALPR and the serum total bilirubin concentration after hepatectomy were uncorrelated.
  
  
  CONCLUSIONS
  ALPR1 is a useful predictor of liver failure after hepatectomy.
authors.affiliation: Department of Surgery II, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan.
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Maeda
authors.forename: Minekatsu
authors.initials: M
authors.lastname: Nishida
authors.forename: Takashi
authors.initials: T
authors.lastname: Takao
authors.forename: Naohide
authors.initials: N
authors.lastname: Mori
authors.forename: Takao
authors.initials: T
authors.lastname: Tamesa
authors.forename: Akira
authors.initials: A
authors.lastname: Tangoku
authors.forename: Masaaki
authors.initials: M
authors.lastname: Oka
mesh_terms: D000368:Aged; D000469:Alkaline Phosphatase / Q000032:analysis / Q000378:metabolism*; D015415:Biomarkers / Q000097:blood; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016009:Chi-Square Distribution; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000009:adverse effects* / Q000379:methods; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D017114:Liver Failure, Acute / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000401:mortality; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D016019:Survival Analysis
chemical_list: D015415:Biomarkers; D000469:Alkaline Phosphatase