title: Predictive scoring system assessing the need for intraoperative blood transfusions during hepatectomy for hepatocellular carcinoma.
abstract: BACKGROUND
  It is of great clinical concern to preoperatively predict the need for blood transfusions during hepatectomy for hepatocellular carcinoma (HCC).
  
  
  METHODS
  A total of 168 consecutive patients undergoing elective hepatectomy for HCC were retrospectively reviewed. We investigated preoperative factors potentially influencing intraoperative blood transfusion and established a predictive scoring system for intraoperative blood transfusion.
  
  
  RESULTS
  Thirty-eight patients (22.6%) received red cell blood transfusion during surgery. A preoperative predicting scoring system for blood transfusion was constructed using the following four factors: platelet count <10×10(4)/mm(3) (2 points), α-fetoprotein ≥80 ng/ml (1 point), tumor size ≥4.0 cm (1 point), and major hepatectomy (1 point). The nomogram showed an area under the curve (AUC) of 0.760. This scoring system was highly predictive for blood transfusion (AUC=0.758). When the score was 0 points, the incidence of intraoperative blood transfusion was 3%. The rate increased to 10% and 38% when the score was 1 and 2 points, respectively, and reached 45% when the score was 3 points or more.
  
  
  CONCLUSIONS
  This predictive scoring system would be useful for preoperatively assessing the need for intraoperative blood transfusions during hepatectomy for HCC.
authors.affiliation: Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku Kyoto 6028566, Japan. ikoma@koto.kpu-m.ac.jp.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Yamamoto
authors.forename: Hisashi
authors.initials: H
authors.lastname: Ikoma
authors.forename: Ryo
authors.initials: R
authors.lastname: Morimura
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Konishi
authors.forename: Yasutoshi
authors.initials: Y
authors.lastname: Murayama
authors.forename: Shuhei
authors.initials: S
authors.lastname: Komatsu
authors.forename: Atsushi
authors.initials: A
authors.lastname: Shiozaki
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Kuriu
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kubota
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Nakanishi
authors.forename: Daisuke
authors.initials: D
authors.lastname: Ichikawa
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Fujiwara
authors.forename: Kazuma
authors.initials: K
authors.lastname: Okamoto
authors.forename: Chouhei
authors.initials: C
authors.lastname: Sakakura
authors.forename: Toshiya
authors.initials: T
authors.lastname: Ochiai
authors.forename: Eigo
authors.initials: E
authors.lastname: Otsuji
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001803:Blood Transfusion; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D006801:Humans; D007430:Intraoperative Care; D008113:Liver Neoplasms / Q000097:blood / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D011183:Postoperative Complications; D011379:Prognosis; D016016:Proportional Hazards Models; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment; D055815:Young Adult
keywords: Preoperative score; blood transfusion; hepatectomy; hepatocellular carcinoma