Postoperative prognosis as related to blood ketone body ratios in hepatectomized patients

20 hepatectomized patients, both cirrhotic and noncirrhotic, were studied for the postoperative changes in the arterial blood ketone body ratio and standard liver function tests. It was found that serum enzyme activities, total protein, albumin, total bilirubin, total cholesterol and prothrombin time were less reliable direct indicators of the onset of postoperative hepatic insufficiency than the arterial blood ketone body ratio, which reflects the oxidoreduction state of liver mitochondria. The hepatectomized patients were classified into three groups according to the postoperative changes in the blood ketone body ratio. In the 8 patients of group A, the blood ketone body ratio did not decrease to below 0.7. In the 7 patients of group B, the blood ketone body ratio decreased transiently to 0.4-0.7 and then increased to over 0.7. In the 5 patients of group C, the blood ketone body ratio decreased irreversibly to below 0.4. There were few postoperative complications in group A. In group B, while a variety of complications occurred, they were ameliorated concomitantly with the restoration of the blood ketone body ratio. All group C patients died of multiple organ failure. It is proposed that the arterial blood ketone body ratio is a new and practical approach which enables more effective postoperative management by the accurate evaluation of hepatic functional reserve after hepatectomy.