Early postoperative liver function parameters as predictors of post-hepatectomy liver failure

Area of Science:

• Hepatobiliary Surgery
• Surgical Outcomes Research
• Liver Function Monitoring

Background:

• Post-hepatectomy liver failure (PHLF) is a significant complication following liver resection, associated with high morbidity and mortality.
• Current diagnostic criteria (ISGLS) rely on laboratory values from postoperative day (POD) 5, potentially delaying critical interventions.

Purpose of the Study:

• To evaluate the predictive value of early postoperative liver function parameters for the development of PHLF.
• To identify optimal cutoffs for early indicators of PHLF on POD 3.

Main Methods:

• Retrospective analysis of 445 patients undergoing elective liver resection.
• Measurement of bilirubin, INR, AST, and ALT on POD 1, 3, and 5.
• Logistic regression and ROC analysis to identify independent predictors and optimal cutoffs for PHLF.

Main Results:

• PHLF developed in 8.5% of patients.
• Significantly elevated bilirubin, INR, AST, and ALT were observed from POD 1 in patients who developed PHLF.
• On POD 3, specific cutoffs for bilirubin (≥1.8 mg/dl), INR (≥1.18), AST (≥179 U/L), and ALT (≥258 U/L) showed significant predictive value for PHLF.
• Major hepatectomy, POD 3 bilirubin and INR, and persistently elevated transaminases were independent predictors of PHLF.

Conclusions:

• Bilirubin and INR on POD 3 are strong independent predictors of PHLF.
• Early assessment of liver function on POD 3 can aid in predicting PHLF, potentially improving patient outcomes.
• Elevated transaminases on POD 3 also serve as valuable prognostic indicators, suggesting their inclusion in future PHLF definitions.