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Child-Pugh Parameters and Platelet Count as an Alternative to ICG Test for Assessing Liver Function for Major

Kin-Pan Au1, See-Ching Chan1, Kenneth Siu-Ho Chok1

  • 1Department of Surgery, The University of Hong Kong, Hong Kong.

HPB Surgery : a World Journal of Hepatic, Pancreatic and Biliary Surgery
|September 28, 2017
PubMed

Insights

This study found that estimated indocyanine green retention at 15 minutes (eICG15), calculated using Child-Pugh scores and platelet count, can predict outcomes after major liver surgery. Higher eICG15 values are associated with increased mortality and reduced survival in hepatocellular carcinoma patients.

Area of Science:

  • Hepatology
  • Surgical Oncology
  • Biostatistics

Background:

  • The Child-Pugh score is a standard method for assessing liver function reserve.
  • The indocyanine green (ICG) clearance test provides another measure of hepatic function.
  • Discrepancies exist between these two systems in predicting patient outcomes.

Purpose of the Study:

  • To investigate the correlation and discrepancies between the Child-Pugh system and ICG clearance test.
  • To explore combining these assessments for a comprehensive liver function evaluation.
  • To determine the predictive value of an estimated ICG clearance test (eICG15) in hepatocellular carcinoma (HCC) patients undergoing major hepatectomy.

Main Methods:

  • Retrospective analysis of 2832 HCC patients classified as Child-Pugh A or B.
  • Performed indocyanine green (ICG) clearance tests on all participants.
  • Developed a regression formula to estimate ICG retention at 15 minutes (eICG15) using Child-Pugh parameters and platelet count.

Main Results:

  • ICG retention at 15 minutes (ICG15) showed correlation with Child-Pugh score but with significant variance.
  • Platelet count improved the correlation between Child-Pugh score and ICG15.
  • Estimated ICG15 (eICG15) was calculated as: 45.1 + 0.435 × bilirubin - 0.917 × albumin + 0.491 × prothrombin time - 0.0283 × platelet (R² = 0.455).
  • Patients with eICG15 >20.0% had higher rates of posthepatectomy liver failure and in-hospital mortality.
  • Higher eICG15 values were linked to shorter overall and disease-free survival.

Conclusions:

  • Estimated ICG15 (eICG15) can be reliably predicted using Child-Pugh parameters and platelet count.
  • eICG15 serves as a valuable predictor of in-hospital mortality following major hepatectomy.
  • eICG15 demonstrates significant utility in predicting long-term survival in HCC patients.
Abstract

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