PREDICTION OF VARIOUS FORMS OF POSTOPERATIVE ACUTE LIVER FAILURE | JoVE Visualize

Area of Science:

Hepatology
Surgical Gastroenterology
Clinical Prognostics

Background:

Postoperative hepatic failure is a significant complication following hepatobiliary surgery.
Accurate prediction of hepatic failure is crucial for patient management and outcomes.
Various scoring systems exist to assess organ dysfunction, but their prognostic value for specific hepatic failure types remains debated.

Purpose of the Study:

To evaluate the prognostic significance of established organ dysfunction scoring systems in predicting postoperative hepatic failure.
To determine the accuracy of scales such as MELD, Child-Turcotte-Pugh, Maddrey, Schindl, BILE score, and SOFA in forecasting specific forms of acute liver failure.
To analyze the predictive performance of these scales for hepatic encephalopathy, hepatic coagulopathy, hepatorenal syndrome, and systemic hemodynamic disorders.

Main Methods:

A cohort of 165 adult patients undergoing hepatobiliary surgery between January 2014 and March 2015 was studied.
Severity of illness and organ dysfunction were assessed preoperatively using MELD, Child-Turcotte-Pugh, Maddrey, Schindl, BILE score, and SOFA.
Incidence of postoperative acute liver failure forms was recorded, and their association with preoperative scores was analyzed using ROC analysis.

Main Results:

The study identified specific forms of acute liver failure, including hepatic encephalopathy, hepatic coagulopathy, hepatorenal syndrome, and mixed forms.
The Child-Turcotte-Pugh score demonstrated good predictive accuracy for hemodynamic dysfunction and hepatic coagulopathy.
MELD and SOFA scores were effective in predicting hepatic encephalopathy, while the Schindl score showed predictive value for hepatorenal syndrome and mixed hepatic failure forms.

Conclusions:

Specialized rating scales possess good predictive accuracy for certain forms of postoperative hepatic insufficiency.
No single analyzed scale demonstrated predictive value for all investigated forms of hepatic failure.
Preoperative assessment using validated scoring systems can aid in predicting specific risks of postoperative liver dysfunction, guiding clinical decision-making.