title: Prospective validation of the "fifty-fifty" criteria as an early and accurate predictor of death after liver resection in intensive care unit patients.
abstract: BACKGROUND
  Postoperative liver failure after hepatectomy has been identified by the association of prothrombin time <50% and serum bilirubin >50 micromol/L (the "50-50" criteria). Whether these criteria are of prognostic value in a prospective study remains unknown.
  
  
  OBJECTIVE
  To determine prospectively the prognostic value of the 50-50 criteria on day 3 and day 5 in intensive care unit (ICU) patients after hepatectomy.
  
  
  METHODS
  From January 2005 to February 2007, among 436 elective liver resections, 99 (23%) consecutive patients aged 58 +/- 17 years were admitted postoperatively in ICU with a mean SAPSII 25 +/- 10. Malignant disease was present in 87 and major resections (< or =3 segments) were performed in 79 (80%) cases. The underlying liver parenchyma was abnormal in 59 (59%) cases including cirrhosis, fibrosis, or steatosis >30% in 19, 23, and 17 patients, respectively.
  
  
  RESULTS
  The 50-50 criteria were present on day 3 in 10 patients and on day 5 in 13. Ten patients (10, 6%) died in ICU. Survivors with these criteria were characterized by early aggressive support including reoperation and/or liver assist system. Nonsurvivors were more often cirrhotic, had significantly higher SAPS II and more frequently postoperative prolonged mechanical ventilation. The 50-50 criteria on days 3 and 5 were predictors of death on multivariate analysis [OR (95% CI): 12.7 (2.3-71.4), OR (95% CI): 29.4 (4.9-167), respectively].
  
  
  CONCLUSIONS
  After hepatic resection, results of this prospective study validate the 50-50 criteria as a predictive factor of mortality in ICU on both days 3 and 5. These criteria allow an early diagnosis of postoperative liver failure, which may contribute to reduce mortality in ICU patients after hepatectomy.
authors.affiliation: Department of Anesthesiology and Critical Care, Beaujon University Hospital, Hôpital Beaujon, Clichy, France. catherine.paugam@bjn.aphp.fr
authors.forename: Catherine
authors.initials: C
authors.lastname: Paugam-Burtz
authors.forename: Sylvie
authors.initials: S
authors.lastname: Janny
authors.forename: Didier
authors.initials: D
authors.lastname: Delefosse
authors.forename: Souhayl
authors.initials: S
authors.lastname: Dahmani
authors.forename: Federica
authors.initials: F
authors.lastname: Dondero
authors.forename: Jean
authors.initials: J
authors.lastname: Mantz
authors.forename: Jacques
authors.initials: J
authors.lastname: Belghiti
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects* / Q000401:mortality*; D006801:Humans; D007362:Intensive Care Units; D017093:Liver Failure / Q000209:etiology* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D015203:Reproducibility of Results; D013997:Time Factors; D055815:Young Adult