Qi Wang1, W Y Lau2, Bixiang Zhang1, Zhiwei Zhang1, Zhiyong Huang1, Hongping Luo1, Xiaoping Chen3. 1. Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. 2. Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Department of Surgery, Prince of Wales Hospital, the Chinese University of Hong Kong, Hong Kong, China. 3. Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. Electronic address: ChenXP@medmail.com.cn.
Abstract
BACKGROUND: Total cholesterol (TC) can reflect the degree of liver damage in patients with chronic hepatitis B or C; its role in evaluating liver functional reserve and predicting postoperative complications remains unknown. METHODS: The prospectively collected data of 996 consecutive patients with chronic hepatitis B or C undergoing partial hepatectomy for hepatocellular carcinoma in a tertiary institution were retrospectively reviewed. The relationship between preoperative TC and postoperative liver insufficiency, morbidity and mortality were analyzed. RESULTS: TC showed significant correlation with postoperative complications on receiver operating characteristic curves, with area under the curve of 0.81 (P < .001), 0.79 (P < .001), and 0.85 (P < .001) for postoperative liver insufficiency, morbidity, and mortality, respectively. Using the calculated cutoff at 2.80 mmol/L, Patients with low TC had worse preoperative liver functional reserve and suffered from more postoperative complications when compared with patients with normal TC (≥2.8 mmol/L). Multivariate analysis revealed that low preoperative TC was more powerful in predicting poor postoperative outcomes than Child-Pugh's classification, indocyanine green (ICG) retention test, and Mayo End-Stage Liver Disease (MELD) score. It was an independent risk factor for postoperative morbidity (odds ratio [OR], 4.87; P < .001) and mortality (OR, 14.60; P < .001). CONCLUSION: Among patients with chronic virus B or C hepatitis receiving partial hepatectomy, a low TC (<2.8 mmol/L) predicted poor postoperative outcomes. It was better than Child-Pugh's classification, ICG, and MELD score in the prediction of postoperative complications, and was useful in the preoperative evaluation of liver functional reserve.
BACKGROUND: Total cholesterol (TC) can reflect the degree of liver damage in patients with chronic hepatitis B or C; its role in evaluating liver functional reserve and predicting postoperative complications remains unknown. METHODS: The prospectively collected data of 996 consecutive patients with chronic hepatitis B or C undergoing partial hepatectomy for hepatocellular carcinoma in a tertiary institution were retrospectively reviewed. The relationship between preoperative TC and postoperative liver insufficiency, morbidity and mortality were analyzed. RESULTS:TC showed significant correlation with postoperative complications on receiver operating characteristic curves, with area under the curve of 0.81 (P < .001), 0.79 (P < .001), and 0.85 (P < .001) for postoperative liver insufficiency, morbidity, and mortality, respectively. Using the calculated cutoff at 2.80 mmol/L, Patients with low TC had worse preoperative liver functional reserve and suffered from more postoperative complications when compared with patients with normal TC (≥2.8 mmol/L). Multivariate analysis revealed that low preoperative TC was more powerful in predicting poor postoperative outcomes than Child-Pugh's classification, indocyanine green (ICG) retention test, and MayoEnd-Stage Liver Disease (MELD) score. It was an independent risk factor for postoperative morbidity (odds ratio [OR], 4.87; P < .001) and mortality (OR, 14.60; P < .001). CONCLUSION: Among patients with chronic virus B or C hepatitis receiving partial hepatectomy, a low TC (<2.8 mmol/L) predicted poor postoperative outcomes. It was better than Child-Pugh's classification, ICG, and MELD score in the prediction of postoperative complications, and was useful in the preoperative evaluation of liver functional reserve.
Authors: E Dudley Colhoun; C Gunnar Forsberg; Kenneth D Chavin; Prabhakar K Baliga; David J Taber Journal: Surgery Date: 2016-10-19 Impact factor: 3.982