title: Dynamic Change of Total Bilirubin after Portal Vein Embolization is Predictive of Major Complications and Posthepatectomy Mortality in Patients with Hilar Cholangiocarcinoma.
abstract: This study aims to evaluate the role of dynamic change in total bilirubin after portal vein embolization (PVE) in predicting major complications and 30-day mortality in patients with hilar cholangiocarcinoma (HCCA).
  
  
  
  Retrospective analysis of prospectively maintained data of 64 HCCA patients who underwent PVE before hepatectomy in our institution was used. Total bilirubin and other parameters were measured daily in peri-PVE period. The difference between them and the baseline value from days 0-5 to day -1 (∆D1) and days 5-14 to day -1 (∆D2) were calculated. The relationship between ∆D1 and ∆D2 of total bilirubin and major complications as well as 30-day mortality was analyzed.
  
  
  
  Out of 64 patients, 10 developed major complications (15.6 %) and 6 patients (9.3 %) had died within 30 days after surgery. The ∆D2 of total bilirubin after PVE was most significantly associated with major complications (P < 0.001) and 30-day mortality (P = 0.002). In addition, it was found to be an independent predictor of major complications after PVE (odds ratio (OR) = 1.050; 95 % CI 1.017-1.084). ASA >3 (OR = 12.048; 95 % CI 1.019-143.321), ∆D2 of total bilirubin (OR = 1.058; 95 % CI 1.007-1.112), and ∆D2 of prealbumin (OR = 0.975; 95 % CI 0.952-0.999) were associated with higher risk of 30-day mortality after PVE. Receiver operating characteristic curves showed that ∆D2 of total bilirubin were better predictors than ∆D1 for major complications (AUC (∆D2) 0.817; P = 0.002 vs. AUC (∆D1) 0.769; P = 0.007) and 30-day mortality (ACU(∆D2) 0.868; P = 0.003 vs. AUC(∆D1) 0.721;P = 0.076).
  
  
  
  Patients with increased total bilirubin in 5-14 days after PVE may indicate a higher risk of major complications and 30-day mortality if the major hepatectomy were performed.
authors.affiliation: Department of Biliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Changhai Road 225, Shanghai, 200438, China.
authors.forename: Qing
authors.initials: Q
authors.lastname: Ou Yang
authors.affiliation: Department of Emergency Medicine, Changzheng Hospital, Second Military Medical University, Shanghai, 200003, China.
authors.forename: Sheng
authors.initials: S
authors.lastname: Zhang
authors.affiliation: Department of Biliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Changhai Road 225, Shanghai, 200438, China.
authors.forename: Qing-Bao
authors.initials: QB
authors.lastname: Cheng
authors.affiliation: Department of Biliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Changhai Road 225, Shanghai, 200438, China.
authors.forename: Bin
authors.initials: B
authors.lastname: Li
authors.affiliation: Department of Biliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Changhai Road 225, Shanghai, 200438, China.
authors.forename: Fei-Ling
authors.initials: FL
authors.lastname: Feng
authors.affiliation: Department of Biliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Changhai Road 225, Shanghai, 200438, China.
authors.forename: Yong
authors.initials: Y
authors.lastname: Yu
authors.affiliation: Department of Biliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Changhai Road 225, Shanghai, 200438, China.
authors.forename: Xiang-Ji
authors.initials: XJ
authors.lastname: Luo
authors.affiliation: Department of Emergency Medicine, Changzheng Hospital, Second Military Medical University, Shanghai, 200003, China. linzhaofen@hotmail.com.
authors.forename: Zhao-Fen
authors.initials: ZF
authors.lastname: Lin
authors.affiliation: Department of Biliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Changhai Road 225, Shanghai, 200438, China. jxq1225@sina.com.
authors.forename: Xiao-Qing
authors.initials: XQ
authors.lastname: Jiang
mesh_terms: D000328:Adult; D000368:Aged; D001650:Bile Duct Neoplasms / Q000401:mortality / Q000601:surgery*; D001663:Bilirubin / Q000097:blood*; D014408:Biomarkers, Tumor / Q000097:blood; D002681:China / Q000453:epidemiology; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects*; D006801:Humans; D018285:Klatskin Tumor / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011169:Portal Vein; D011183:Postoperative Complications / Q000097:blood / Q000453:epidemiology / Q000517:prevention & control*; D011300:Preoperative Care / Q000379:methods*; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D014408:Biomarkers, Tumor; D001663:Bilirubin
keywords: Hilar cholangiocarcinoma; Major complications; Portal vein embolization; Posthepatectomy mortality; Total bilirubin
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