A comprehensive method for predicting fatal liver failure of patients with liver cancer resection.
There are many methods to assess liver function, but none of them has been verified as fully effective. The purpose of this study is to establish a comprehensive method evaluating perioperative liver reserve function (LRF) in patients with primary liver cancer (PLC).In this study, 310 PLC patients who underwent liver resection were included. The cohort was divided into a training set (n = 235) and a validation set (n = 75). The factors affecting postoperative liver dysfunction (POLD) during preoperative, intraoperative, and postoperative periods were confirmed by logistic regression analysis. The equation for calculating the preoperative liver functional evaluation index (PLFEI) was established; the cutoff value of PLFEI determined through analysis by receiver-operating characteristic curve was used to predict postoperative liver function.The data showed that body mass index, international normalized ratio, indocyanine green (ICG) retention rate at 15 minutes (ICGR15), ICG elimination rate, standard remnant liver volume (SRLV), operative bleeding volume (OBV), blood transfusion volume, and operative time were statistically different (all P < 0.05) between 2 groups of patients with and without POLD. The relationship among PLFEI, ICGR15, OBV, and SRLV is expressed as an equation of "PLFEI = 0.181 × ICGR15 + 0.001 × OBV - 0.008 × SRLV." The cutoff value of PLFEI to predict POLD was -2.16 whose sensitivity and specificity were 90.3% and 73.5%, respectively. However, when predicting fatal liver failure (FLF), the cutoff value of PLFEI was switched to -1.97 whose sensitivity and specificity were 100% and 68.8%, respectively.PLFEI will be a more comprehensive, sensitive, and accurate index assessing perioperative LRF in liver cancer patients who receive liver resection. And keeping PLFEI <-1.97 is a safety margin for preventing FLF in PLC patients who underwent liver resection.
From the Department of Hepatobiliary and Pancreatic Surgery (JL, LL, SAT, SH); Laboratory of Hepatobiliary and Pancreatic Surgery (JL, BL, JJ, SH), Affiliated Hospital of Guilin Medical University; Guangxi Key Laboratory of Molecular Medicine in Liver Injury and Repair (JJ, SH); School of Public Health (WS), Guilin Medical University, Guilin, Guangxi, People's Republic of China; and Department of Radiology and Radiological Science (XN), Center for Biomedical Imaging, Medical University of South Carolina, Charleston, South Carolina, USA.
Jiangfa
J
Li
Biao
B
Lei
Xingju
X
Nie
Linku
L
Lin
Syed Abdul
SA
Tahir
Wuxiang
W
Shi
Junfei
J
Jin
Songqing
S
He
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001803:Blood Transfusion / Q000706:statistics & numerical data; D015992:Body Mass Index; D004396:Coloring Agents / Q000378:metabolism; D005260:Female; D006470:Hemorrhage / Q000453:epidemiology; D006498:Hepatectomy; D006801:Humans; D007208:Indocyanine Green / Q000378:metabolism; D019934:International Normalized Ratio; D017093:Liver Failure / Q000175:diagnosis* / Q000401:mortality*; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000503:physiopathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D009929:Organ Size; D011237:Predictive Value of Tests; D012307:Risk Factors; D012680:Sensitivity and Specificity
D004396:Coloring Agents; D007208:Indocyanine Green