title: An accurate predictor of liver failure and death after hepatectomy: a single institution's experience with 478 consecutive cases.
abstract: OBJECTIVE
  To establish a reliable definition of postoperative liver failure (PLF) and allow the prediction of outcomes after hepatectomy.
  
  
  METHODS
  The clinical data of 478 consecutive patients who underwent hepatectomy were retrospectively analyzed. The examined prognostic factors included the ratio of total bilirubin (TBIL) on postoperative day (POD) X to TBIL on POD 1 (TBIL-r1) and the ratio of the international normalized ratio (INR) on POD X to the INR on POD 1 (INR-r1) for PODs 3, 5 and 7. Student's t test, the χ(2) test, logistic regression, survival analysis and receiver operating curve analysis were used to evaluate risk factors and establish the definition of postoperative liver failure (PLF).
  
  
  RESULTS
  Fourteen patients (2.9%) died of liver failure within 3 mo of surgery. Significant differences were found between patients who died of liver failure and the remaining patients in terms of TBIL-r1 and INR-r1 on PODs 3, 5 and 7. The combination of TBIL-r1 and INR-r1 on POD 5 showed strong predictive power for liver failure-related death (sensitivity 92.9% and specificity 90.1%). The hepatic damage score (HDs), which was derived from TBIL-r1 and INR-r1, was used to define the degree of metabolic functional impairment after resection as mild (HDs = 0), reversible hepatic "dysfunction" (HDs = 1) or fatal hepatic failure (HDs = 2). Furthermore, the indocyanine green retention rate at 15 min (ICG-R15) and the number of resected segments (RSs) were identified as independent predictors of the HDs. A linear relationship was found between ICG-R15 and RSs in the HDs = 2 group. The regression equation was: RSs = -0.168 × ICG-R15 + 5.625 (r (2) = 0.613, F = 14.257, P = 0.004).
  
  
  CONCLUSIONS
  PLF can be defined by the HDs, which accurately predicts liver failure-related death after liver resection. Furthermore, the ICG-R15 and RSs can be used as selection criteria for hepatectomy.
authors.affiliation: Zheng-Gui Du, Yong-Gang Wei, Ke-Fei Chen, Bo Li, Department of Liver Surgery, Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
authors.forename: Zheng-Gui
authors.initials: ZG
authors.lastname: Du
authors.affiliation: Zheng-Gui Du, Yong-Gang Wei, Ke-Fei Chen, Bo Li, Department of Liver Surgery, Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
authors.forename: Yong-Gang
authors.initials: YG
authors.lastname: Wei
authors.affiliation: Zheng-Gui Du, Yong-Gang Wei, Ke-Fei Chen, Bo Li, Department of Liver Surgery, Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
authors.forename: Ke-Fei
authors.initials: KF
authors.lastname: Chen
authors.affiliation: Zheng-Gui Du, Yong-Gang Wei, Ke-Fei Chen, Bo Li, Department of Liver Surgery, Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
authors.forename: Bo
authors.initials: B
authors.lastname: Li
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001663:Bilirubin / Q000097:blood; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D003661:Decision Support Techniques; D005260:Female; D005456:Fluorescent Dyes; D006498:Hepatectomy / Q000009:adverse effects* / Q000401:mortality*; D006801:Humans; D007208:Indocyanine Green; D019934:International Normalized Ratio; D053208:Kaplan-Meier Estimate; D016014:Linear Models; D017093:Liver Failure / Q000097:blood / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality*; D008111:Liver Function Tests; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D015415:Biomarkers; D005456:Fluorescent Dyes; D007208:Indocyanine Green; D001663:Bilirubin
keywords: Hepatectomy; Hepatic dysfunction; Liver failure; Morbidity; Mortality