Early drain fluid lymphocyte fraction as a predictor of postoperative infectious complications after hepatectomy
Kenei Furukawa1, Masashi Tsunematsu2, Koichiro Haruki2
1Division of Hepatobiliary and Pancreas Surgery, Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan. k-furukawa@jikei.ac.jp.
Purpose:
Postoperative infectious complications remain one of the most common morbidities after hepatectomy. We conducted this study to evaluate whether the lymphocyte fraction in drain fluid could serve as a surrogate marker of postoperative infectious complications after hepatectomy.
Methods:
The subjects of this retrospective analysis were 265 patients who underwent hepatectomy. Drain fluid samples were collected on postoperative day (POD) 1, for biochemical and hematologic evaluation. The associations between the lymphocyte fraction in drain fluid and postoperative infectious complications were examined using univariate and multivariate logistic regression analyses.
Results:
Postoperative infectious complications developed in 43 patients (16%). Multivariate analysis identified biliary reconstruction (odds ratio (OR) 4.20, p = 0.02), total bilirubin concentration in drain fluid ≥ 1.0 mg/dL (OR 3.32, p < 0.01), and lymphocyte fraction in drain fluid < 0.7% (OR 4.09, p < 0.01) as independent risk factors. No correlation was found between peripheral blood and drain fluid lymphocyte fractions (r = 0.02, p = 0.77).
Conclusion:
A reduced lymphocyte fraction in drain fluid on POD1 is an independent predictor of postoperative infectious complications after hepatectomy and may reflect the postoperative local immune environment rather than systemic immunity.
Insights
A low lymphocyte fraction in surgical drain fluid after hepatectomy predicts infectious complications. This marker may indicate local immune changes, not systemic immunity, aiding early detection.
Area of Science:
- Hepatobiliary surgery
- Surgical oncology
- Infectious disease diagnostics
Background:
- Postoperative infectious complications are a significant concern following hepatectomy.
- Identifying reliable early markers for these complications is crucial for patient outcomes.
Purpose of the Study:
- To investigate the utility of the lymphocyte fraction in surgical drain fluid as a predictive marker for postoperative infectious complications after hepatectomy.
- To determine if drain fluid lymphocyte fraction correlates with systemic immunity.
Main Methods:
- Retrospective analysis of 265 patients undergoing hepatectomy.
- Collection and analysis of drain fluid samples on postoperative day 1.
- Statistical analysis including univariate and multivariate logistic regression.
Main Results:
- Postoperative infectious complications occurred in 16% of patients.
- Independent risk factors identified include biliary reconstruction, high drain fluid bilirubin, and a low drain fluid lymphocyte fraction (<0.7%).
- No significant correlation was observed between peripheral blood and drain fluid lymphocyte fractions.
Conclusions:
- A reduced lymphocyte fraction in drain fluid on postoperative day 1 is an independent predictor of infectious complications after hepatectomy.
- This finding suggests the drain fluid lymphocyte fraction reflects the local postoperative immune environment.
- The drain fluid lymphocyte fraction may serve as a valuable, localized biomarker for predicting complications.
