Prognostic utility of postoperative C-reactive protein for posthepatectomy liver failure.
OBJECTIVE
C-reactive protein (CRP) is an acute-phase protein produced by the liver. We hypothesize that an early dampened CRP response after major liver resection is of prognostic importance in predicting posthepatectomy liver failure (PHLF).


METHODS
Serum CRP levels were determined on postoperative days 1, 3, and 7 in patients undergoing liver resection (stratified into minor [</=2 segments], standard [3 or 4 segments], and extended [>/=5 segments]). Correlations were made with indices of PHLF (hyperbilirubinemia, coagulopathy, ascites, and encephalopathy), multi-organ dysfunction syndrome, sepsis, and death.


METHODS
Division of Hepatobiliary and Transplant Surgery, Leeds Teaching Hospitals National Health Service Trust, England.


METHODS
One hundred thirty-eight individuals who underwent liver resection.


METHODS
Sepsis, PHLF, and mortality.


RESULTS
A total of 138 liver resections (39 minor, 51 standard, and 48 extended) were included. Median serum CRP levels on day 1 were significantly lower after extended liver resection (28 mg/L; range, 5-119 mg/L [to convert to nanomoles per liter, multiply by 9.524]) compared with standard resection (41 mg/L; range, 5-85 mg/L) and minor resection (51 mg/L; range, 8-203 mg/L; chi(2) = 19; P < .001). Similar differences were observed on day 3 (chi(2) = 27; P < .001). Postoperative day 1 CRP levels were significantly lower in patients developing PHLF (hyperbilirubinemia, P = .001; ascites, P < .001; coagulopathy, P = .002; and encephalopathy, P < .001) or multiorgan dysfunction syndrome (P = .009) or who died (P = .01). Day 1 serum CRP levels and extent of resection were independent predictors of PHLF in multivariate analysis.


CONCLUSIONS
The early dampened CRP response after major liver resection may reflect poor hepatic reserve that could have prognostic utility.
Rahman
Sakhawat H
SH
Royal Free Hospital, Pond Street, London NW3 2QG, England. zak-rahman@lineone.net
Evans
Jessica
J
Toogood
Giles J
GJ
Lodge
Peter A
PA
Prasad
K Rajendra
KR
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002097:C-Reactive Protein / Q000032:analysis*; D006498:Hepatectomy / Q000009:adverse effects*; D006801:Humans; D017093:Liver Failure / Q000097:blood* / Q000209:etiology; D008875:Middle Aged; D011184:Postoperative Period; D011379:Prognosis
D002097:C-Reactive Protein