Assessment of nutritional status and prediction of postoperative liver function from serum apolioprotein A-1 levels with hepatectomy.
BACKGROUND
We investigated the usefulness of apolipoprotein A-1 (apoA) as an indicator of nutritional status, and the correlation of the preoperative apoA level with changes in postoperative liver function following hepatectomy.


METHODS
One hundred patients underwent hepatectomy. Serum levels of apoA, prealbumin (prealb), retinol-binding protein (RBP), lectin-cholesterol acyltransferase (LCAT), hyarulonate (HA), indocyanine green dye retention at 15 minutes (ICG), and the receptor index of Tc-GSA scintigraphy (LHL15) were measured at preoperation and on postoperative days (POD) 7 and 14. Partial resection was carried out in 62 cases, segmentectomy in nine cases, and bisegmentectomy in 29 cases. Co-existent liver conditions were normal liver (NL) in 43 cases, chronic hepatitis (CH) in 29 cases, and liver cirrhosis (LC) in 28 cases.


RESULTS
In most cases the serum apoA level had decreased on POD 7, and recovered on POD 14. There were no significant differences in the changes of apoA between the individual operative procedures. Although preoperative apoA had almost the same value in the NL, CH, and LC cases, apoA in LC cases on POD 14 was the lowest of all cases. The apoA level showed significant correlations with prealb, LCAT, and HA on POD 14. All cases were divided into two groups (group N: apoA over 91 mg/dl; group L: apoA under 90 mg/dl) based on the preoperative serum apoA level. On POD 14, the ICG, LHL15, and HA of group L were significantly deteriorated compared with those of group L.


CONCLUSIONS
The serum level of apoA reflects the changes in hepatic protein synthetic ability after hepatectomy; therefore, it may be possible to estimate recovery of nutritional status after hepatectomy from serum apoA. Moreover, we can predict postoperative deterioration of liver function from the preoperative apoA level.
Katsuramaki
Tadashi
T
First Department of Surgery, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, Japan. katsuram@sapmed.ac.jp
Mizuguchi
Toru
T
Kawamoto
Masaki
M
Yamaguchi
Kouji
K
Meguro
Makoto
M
Nagayama
Minoru
M
Nobuoka
Takayuki
T
Kimura
Yasutoshi
Y
Furuhata
Tomohisa
T
Hirata
Koichi
K
D000328:Adult; D000368:Aged; D016632:Apolipoprotein A-I / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D006801:Humans; D008107:Liver Diseases / Q000097:blood* / Q000601:surgery*; D008111:Liver Function Tests; D008115:Liver Regeneration / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status / Q000502:physiology*; D011184:Postoperative Period; D011379:Prognosis; D012189:Retrospective Studies
D016632:Apolipoprotein A-I; D015415:Biomarkers