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Early postoperative serum aspartate aminotransferase for prediction of post-hepatectomy liver failure
Watoo Vassanasiri1, Narongsak Rungsakulkij2, Wikran Suragul1
1Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Praram VI Road, Ratchathewi, Bangkok, 10400, Thailand.
Insights
Early detection of post-hepatectomy liver failure (PHLF) is crucial. Elevated serum AST on postoperative day 1 can predict PHLF, enabling earlier intervention for at-risk patients.
Area of Science:
- Hepatobiliary Surgery
- Surgical Complications
- Liver Function Tests
Background:
- Post-hepatectomy liver failure (PHLF) is a significant complication following liver resection.
- Current diagnostic criteria (ISGLS) rely on data from postoperative day 5, potentially delaying critical interventions.
Purpose of the Study:
- To investigate the association between early postoperative (POD1) serum aminotransferase levels and the development of PHLF.
- To identify early predictive markers for PHLF risk.
Main Methods:
- Retrospective analysis of 890 patients undergoing hepatectomy between 2008-2019.
- Comparison of preoperative, intraoperative, and early postoperative laboratory data (AST, ALT, bilirubin, INR) between PHLF and non-PHLF groups.
Main Results:
- 3.4% of patients developed PHLF.
- POD1 cut-off values of AST > 260 U/L and ALT > 270 U/L predicted PHLF.
- Independent predictors of PHLF included POD1 AST > 260 U/L, ICG-R15, major hepatectomy, blood loss, and INR.
Conclusions:
- Elevated serum AST on POD1 serves as an early warning sign for PHLF risk.
- Early identification allows for prompt initiation of active management and vigilant monitoring.
- This approach can improve patient outcomes by enabling earlier intervention.
Background:
Post-hepatectomy liver failure (PHLF) is a serious complication of hepatectomy. The current criteria for PHLF diagnosis (ISGLS consensus) require laboratory data on or after postoperative day (POD) 5, which may delay treatment for patients at risk. The present study aimed to determine the associations between early postoperative (POD1) serum aminotransferase levels and PHLF.
Methods:
The medical records of patients who underwent hepatectomy at Ramathibodi Hospital from January 2008 to December 2019 were retrospectively examined. Patients were classified into PHLF and non-PHLF groups. Preoperative characteristics, intraoperative findings, and early postoperative laboratory data (serum AST, ALT, bilirubin, and international normalized ratio (INR) on POD0 to POD5) were analyzed.
Results:
A total of 890 patients were included, of whom 31 (3.4%) had PHLF. Cut-off points for AST of 260 U/L and ALT of 270 U/L on POD1 were predictive of PHLF. In multivariate analysis, AST > 260 U/L on POD1, ICG-R15, major hepatectomy, blood loss, and INR were independently associated with PHLF.
Conclusions:
Early warning from elevated serum AST on POD1, before a definitive diagnosis of PHLF is made on POD5, can help alert physicians that a patient is at risk, meaning that active management and vigilant monitoring can be initiated as soon as possible.
