Indocyanine green disappearance rate is the most useful marker for liver resection.
OBJECTIVE
Non-invasive measurement of indocyanine green plasma disappearance rate (PDR(ICG)) is supposed to be an accurate liver function parameter. However, its value compared to conventional markers like bilirubin and prothrombin time (PT) is unclear. The authors therefore prospectively determined PDR(ICG) and bilirubin and PT and recorded the clinical course after liver resection.


METHODS
Ninety-six patients underwent liver resection. Three patients died due to liver failure. Twenty patients (21%) developed signs of liver dysfunction. Receiver operating curve (ROC) analysis was performed to assess the value of each parameter to detect postoperative liver failure and dysfunction.


RESULTS
PDR(ICG) and PT but not bilirubin preoperatively differentiated between patients with and without cirrhosis. In cirrhosis, PDR(ICG) patients did not recover to preoperative baseline values. ROC analysis revealed that PDR(ICG) [area under the curve (AUC): 0.867] did significantly better indicate postoperative liver dysfunction than bilirubin (AUC: 0.633) and PT (AUC: 0.570).


CONCLUSIONS
PDR(ICG) should be measured preoperatively and daily after liver resection in patients at risk (underlying liver disease, resections > 30% standard liver volume).
Scheingraber
Stefan
S
Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital, University of Saarland, D-66421 Homburg, Germany. stefan.scheingraber@kkh-vilsbiburg.de
Richter
Sven
S
Igna
Dorian
D
Flesch
Sarah
S
Kopp
Berit
B
Schilling
Martin K
MK
D000368:Aged; D015331:Cohort Studies; D004396:Coloring Agents / Q000493:pharmacokinetics*; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects*; D048550:Hepatic Insufficiency / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D007208:Indocyanine Green / Q000493:pharmacokinetics*; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000097:blood* / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012372:ROC Curve; D016896:Treatment Outcome
D004396:Coloring Agents; D007208:Indocyanine Green