title: Serum antithrombin III level is well correlated with multiple indicators for assessment of liver function and diagnostic accuracy for predicting postoperative liver failure in hepatocellular carcinoma patients.
abstract: OBJECTIVE
  Evaluation of preoperative hepatic reserve is critical to avoid a fatal clinical course such as liver failure. We retrospectively evaluated 158 consecutive hepatocellular carcinoma (HCC) patients who underwent initial hepatectomy. The aim of this study was to determine the correlations of multiple indicators for assessment of liver function before hepatectomy. Furthermore, diagnostic probability for the pathological background and prediction of postoperative liver failure/dysfunction was compared between the antithrombin (AT) III level and indocyanine green retention rate at 15 minutes (ICGR15).
  
  
  METHODS
  Between January 2001 and March 2008, 158 HCC patients who underwent initial hepatectomy were enrolled in this study. Spearman's correlation coefficients (r values) were obtained for 15 clinical laboratory tests including ATIII and ICGR15. Receiver operating characteristic (ROC) curve analysis was used for calculating the probability and predictive ability of the tests.
  
  
  RESULTS
  All 158 consecutive HCC patients were eligible for hepatectomy based on the Japanese guideline. ATIII is correlated with 13 of 14 other clinical tests, including albumin, bilirubin, prothrombin time, rapid turnover proteins, HGF, ICGR15 and others. The diagnostic probabilities to distinguish between normal liver and other pathological backgrounds of ATIII and ICGR15 were significantly different. The specificity of ATIII to predict postoperative liver failure/dysfunction was higher than that of ICGR15.
  
  
  CONCLUSIONS
  The serum ATIII level before hepatectomy is valuable to estimate the pathological background and predict postoperative liver failure/ dysfunction. It should be possible to use ATIII as an additional indicator for liver function and substitute for ICGR15 in the future.
authors.affiliation: Department of Surgery I, Sapporo Medical University Hospital, Hokkaido, Japan. tmizu@sapmed.ac.jp
authors.forename: Toru
authors.initials: T
authors.lastname: Mizuguchi
authors.forename: Masaki
authors.initials: M
authors.lastname: Kawamoto
authors.forename: Makoto
authors.initials: M
authors.lastname: Meguro
authors.forename: Seiichi
authors.initials: S
authors.lastname: Son
authors.forename: Yukio
authors.initials: Y
authors.lastname: Nakamura
authors.forename: Kohei
authors.initials: K
authors.lastname: Harada
authors.forename: Toshihito
authors.initials: T
authors.lastname: Shibata
authors.forename: Shigenori
authors.initials: S
authors.lastname: Ota
authors.forename: Koichi
authors.initials: K
authors.lastname: Hirata
mesh_terms: D000368:Aged; D000990:Antithrombin III / Q000032:analysis*; D014408:Biomarkers, Tumor / Q000032:analysis*; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000473:pathology / Q000601:surgery*; D004396:Coloring Agents; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects*; D006801:Humans; D007208:Indocyanine Green; D016014:Linear Models; D017093:Liver Failure / Q000097:blood / Q000209:etiology*; 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; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
chemical_list: D014408:Biomarkers, Tumor; D004396:Coloring Agents; C542513:SERPINC1 protein, human; D000990:Antithrombin III; D007208:Indocyanine Green