title: Validation of the peak bilirubin criterion for outcome after partial hepatectomy.
abstract: Postoperative liver failure (PLF) is a dreaded complication after partial hepatectomy. The peak bilirubin criterion (>7.0 mg/dL or ≥120 μmol/L) is used to define PLF. This study aimed to validate the peak bilirubin criterion as postoperative risk indicator for 90-day liver-related mortality.
  
  
  
  Characteristics of 956 consecutive patients who underwent partial hepatectomy at the Maastricht University Medical Centre or Royal Free London between 2005 and 2012 were analyzed by uni- and multivariable analyses with odds ratios (OR) and 95% confidence intervals (95%CI).
  
  
  
  Thirty-five patients (3.7%) met the postoperative peak bilirubin criterion at median day 19 with a median bilirubin level of 183 [121-588] μmol/L. Sensitivity and specificity for liver-related mortality after major hepatectomy were 41.2% and 94.6%, respectively. The positive predictive value was 22.6%. Predictors of liver-related mortality were the peak bilirubin criterion (p < 0.001, OR = 15.9 [95%CI 5.2-48.7]), moderate-severe steatosis and fibrosis (p = 0.013, OR = 8.5 [95%CI 1.6-46.6]), ASA 3-4 (p = 0.047, OR = 3.0 [95%CI 1.0-8.8]) and age (p = 0.044, OR = 1.1 [95%CI 1.0-1.1]).
  
  
  
  The peak bilirubin criterion has a low sensitivity and positive predictive value for 90-day liver-related mortality after major hepatectomy.
authors: Department of Surgery, Maastricht University Medical Centre and NUTRIM School of Nutrition and Translational Research, Maastricht University, Maastricht, The Netherlands.
authors: Kim M C
authors: KMC
authors: van Mierlo
authors: Department of Surgery, Maastricht University Medical Centre and NUTRIM School of Nutrition and Translational Research, Maastricht University, Maastricht, The Netherlands; Department of Surgery, University Hospital Aachen, Division of General, Visceral and Transplantation Surgery, Aachen, Germany.
authors: Toine M
authors: TM
authors: Lodewick
authors: Department of Surgery, Royal Free & Institute for Liver and Digestive Health University College London Hospitals, and University College London, London, United Kingdom; Organ Transplantation Centre and Comparative Medicine Department, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
authors: Dipok K
authors: DK
authors: Dhar
authors: Department of Surgery, Maastricht University Medical Centre and NUTRIM School of Nutrition and Translational Research, Maastricht University, Maastricht, The Netherlands.
authors: Victor
authors: V
authors: van Woerden
authors: Department of Surgery, Maastricht University Medical Centre and NUTRIM School of Nutrition and Translational Research, Maastricht University, Maastricht, The Netherlands.
authors: Ralph
authors: R
authors: Kurstjens
authors: Department of Surgery, Maastricht University Medical Centre and NUTRIM School of Nutrition and Translational Research, Maastricht University, Maastricht, The Netherlands.
authors: Frank G
authors: FG
authors: Schaap
authors: Department of Surgery, Maastricht University Medical Centre and NUTRIM School of Nutrition and Translational Research, Maastricht University, Maastricht, The Netherlands.
authors: Ronald M
authors: RM
authors: van Dam
authors: Department of Surgery, Royal Free & Institute for Liver and Digestive Health University College London Hospitals, and University College London, London, United Kingdom.
authors: Soumil
authors: S
authors: Vyas
authors: Department of Surgery, Royal Free & Institute for Liver and Digestive Health University College London Hospitals, and University College London, London, United Kingdom.
authors: Massimo
authors: M
authors: Malagó
authors: Department of Surgery, Maastricht University Medical Centre and NUTRIM School of Nutrition and Translational Research, Maastricht University, Maastricht, The Netherlands; GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands.
authors: Cornelis H C
authors: CHC
authors: Dejong
authors: Department of Surgery, Maastricht University Medical Centre and NUTRIM School of Nutrition and Translational Research, Maastricht University, Maastricht, The Netherlands; Department of Surgery, Royal Free & Institute for Liver and Digestive Health University College London Hospitals, and University College London, London, United Kingdom. Electronic address: steven.oldedamink@maastrichtuniversity.nl.
authors: Steven W M
authors: SWM
authors: Olde Damink
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001663:Bilirubin / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects* / Q000401:mortality; D006801:Humans; D017093:Liver Failure / Q000097:blood* / Q000175:diagnosis / Q000401:mortality; D016015:Logistic Models; D008131:London; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009426:Netherlands; D016017:Odds Ratio; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D015854:Up-Regulation; D055815:Young Adult
chemical_list: D015415:Biomarkers; D001663:Bilirubin