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A Simple Index to Predict Liver Functional Reserve after Hepatectomy
Hepato-Gastroenterology
|July 16, 2015
Summary
Prothrombin percentage (PT%) is a simple, noninvasive predictor of early liver failure (ELF) and mortality from recurrence-free liver failure (MLF) after hepatectomy in patients with severe chronic liver disease. A preoperative PT% of ≤ 70 accurately predicted these outcomes.
Area of Science:
- Hepatobiliary surgery
- Surgical oncology
- Liver disease research
Background:
- Estimating liver functional reserve is crucial for safe hepatectomy in patients with severe chronic liver disease.
- Predicting early liver failure (ELF) and late liver failure (mortality from recurrence-free liver failure - MLF) post-hepatectomy remains challenging.
- Current methods may not be sufficiently accurate or noninvasive for all patients.
Purpose of the Study:
- To develop a simple model using routine laboratory data to predict ELF and MLF after hepatectomy.
- To identify reliable noninvasive markers for assessing liver functional reserve.
- To compare the predictive accuracy of Prothrombin Percentage (PT%) with Indocyanine Green Retention Test at 15 minutes (ICG-R15).
Main Methods:
- Retrospective analysis of 127 patients who underwent minor hepatectomy between 2000 and 2004.
- Evaluation of routine laboratory data, including PT%, Total Bilirubin (TB), and Direct Bilirubin (DB).
- Assessment of Prothrombin Percentage (PT%) and ICG-R15 for predicting ELF and MLF.
Main Results:
- Prothrombin Percentage (PT%) was the best predictor for both ELF and MLF, with AUCs of 0.70 and 0.81, respectively.
- A preoperative PT% threshold of ≤ 70 accurately predicted ELF in 77% of patients and MLF in 87% of patients.
- ICG-R15 did not accurately predict ELF or MLF across any cut-off values.
Conclusions:
- Prothrombin Percentage (PT%) is a simple, noninvasive index for estimating liver functional reserve.
- PT% effectively predicts both early liver failure (ELF) and mortality from recurrence-free liver failure (MLF) after hepatectomy.
- PT% offers a more reliable alternative to ICG-R15 for predicting liver failure post-hepatectomy.
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