PREDICTION OF VARIOUS FORMS OF POSTOPERATIVE ACUTE LIVER FAILURE

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.