title: Indocyanine green retention is a potential prognostic indicator after splenectomy and pericardial devascularization for cirrhotic patients.
abstract: BACKGROUND
  Splenectomy and pericardial devascularization (SPD) is an effective treatment of upper gastrointestinal bleeding and hypersplenism in cirrhotic patients with portal hypertension. Indocyanine green retention at 15 minutes (ICGR15) was reported to offer better sensitivity and specificity than the Child-Pugh classification in hepatectomy, but few reports describe ICGR15 in SPD. The present study was to evaluate the prognostic value of ICGR15 for cirrhotic patients with portal hypertension who underwent SPD.
  
  
  METHODS
  From January 2012 to January 2015, 43 patients with portal hypertension and hypersplenism caused by liver cirrhosis were admitted in our center and received SPD. The ICGR15, Child-Pugh classification, model for end-stage liver disease (MELD) score, and perioperative characteristics were analyzed retrospectively.
  
  
  RESULTS
  Preoperative liver function assessment revealed that 34 patients were Child-Pugh class A with ICGR15 of 13.6%-43.0% and MELD score of 7-20; 8 patients were class B with ICGR15 of 22.8%-40.7% and MELD score of 7-17; 1 patient was class C with ICGR15 of 39.7% and MELD score of 22. The optimal ICGR15 threshold for liver function compensation was 31.2%, which offered a sensitivity of 68.4% and a specificity of 70.8%. Univariate analysis showed preoperative ICGR15, MELD score, surgical procedure, intraoperative blood loss, and autologous blood transfusion were significantly different between postoperative liver function compensated and decompensated groups. Multivariate regression analysis revealed that ICGR15 was an independent risk factor of postoperative liver function recovery (P=0.020).
  
  
  CONCLUSIONS
  ICGR15 has outperformed the Child-Pugh classification for assessing liver function in cirrhotic patients with portal hypertension. ICGR15 may be a suitable prognostic indicator for cirrhotic patients after SPD.
authors: Department of Hepatopancreaticobiliary Surgery & Laparoscopic Minimally Invasive Surgery, Zhejiang Provincial People's Hospital, Hangzhou 310014, China. hongdefi@163.com.
authors: Yuan-Biao
authors: YB
authors: Zhang
authors: Yi
authors: Y
authors: Lu
authors: Wei-Ding
authors: WD
authors: Wu
authors: Cheng-Wu
authors: CW
authors: Zhang
authors: Guo-Liang
authors: GL
authors: Shen
authors: de-Fei
authors: dF
authors: Hong
mesh_terms: D000328:Adult; D019540:Area Under Curve; D016009:Chi-Square Distribution; D005260:Female; D005456:Fluorescent Dyes / Q000008:administration & dosage*; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D006489:Hemostatic Techniques / Q000009:adverse effects; D006801:Humans; D006971:Hypersplenism / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D006975:Hypertension, Portal / Q000175:diagnosis* / Q000209:etiology; D007208:Indocyanine Green / Q000008:administration & dosage*; D008103:Liver Cirrhosis / Q000150:complications / Q000175:diagnosis*; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010496:Pericardium / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology; D011237:Predictive Value of Tests; D012372:ROC Curve; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D013156:Splenectomy / Q000009:adverse effects; D016896:Treatment Outcome
chemical_list: D005456:Fluorescent Dyes; D007208:Indocyanine Green