Liver dysfunction and sepsis determine operative mortality after liver resection.
BACKGROUND
Liver failure is the principal cause of death after hepatectomy. Its progression towards death and its relationship with sepsis are unclear. This study analysed predictors of mortality in patients with liver dysfunction and the role of sepsis in the death of these patients.


METHODS
The study focused on patients with liver dysfunction, excluding those with vascular thrombosis, after liver resection at one of two centres between 1998 and 2006.


RESULTS
Liver dysfunction occurred after 57 (4.5 per cent) of 1271 hepatectomies. Fifty-three patients without vascular thrombosis were included in the analysis, with a mortality rate of 23 per cent. Independent predictors of death were age (odds ratio (OR) 1.18 per year increase; P = 0.017), cirrhosis (OR 54.09; P = 0.004) and postoperative sepsis (OR 37.58; P = 0.005). Sepsis occurred in 15 patients (28 per cent), seven of whom died. Intestinal pathogens were isolated in 12 patients with sepsis. The risk of sepsis was significantly increased in those with surgical complications (11 of 16 versus four of 37; P < 0.001).


CONCLUSIONS
Sepsis plays a key role in the death of patients with liver dysfunction after hepatectomy. Early recognition and aggressive treatment of sepsis may reduce mortality.
Capussotti
L
L
Department of Hepatopancreatobiliary and Digestive Surgery, Ospedale Mauriziano Umberto I, Largo Turati 62, Turin, Italy. lcapussotti@mauriziano.it
Viganò
L
L
Giuliante
F
F
Ferrero
A
A
Giovannini
I
I
Nuzzo
G
G
D000328:Adult; D000368:Aged; D042241:Early Diagnosis; D005260:Female; D006498:Hepatectomy / Q000401:mortality*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000175:diagnosis / Q000401:mortality; D017093:Liver Failure / Q000175:diagnosis / Q000209:etiology / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology / Q000401:mortality*; D011446:Prospective Studies; D012189:Retrospective Studies; D018805:Sepsis / Q000175:diagnosis / Q000209:etiology / Q000401:mortality*; D055815:Young Adult