Kim M C van Mierlo1, Toine M Lodewick2, Dipok K Dhar3, Victor van Woerden1, Ralph Kurstjens1, Frank G Schaap1, Ronald M van Dam1, Soumil Vyas4, Massimo Malagó4, Cornelis H C Dejong5, Steven W M Olde Damink6. 1. Department of Surgery, Maastricht University Medical Centre and NUTRIM School of Nutrition and Translational Research, Maastricht University, Maastricht, The Netherlands. 2. Department of Surgery, Maastricht University Medical Centre and NUTRIM School of Nutrition and Translational Research, Maastricht University, Maastricht, The Netherlands; Department of Surgery, University Hospital Aachen, Division of General, Visceral and Transplantation Surgery, Aachen, Germany. 3. Department of Surgery, Royal Free & Institute for Liver and Digestive Health University College London Hospitals, and University College London, London, United Kingdom; Organ Transplantation Centre and Comparative Medicine Department, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia. 4. Department of Surgery, Royal Free & Institute for Liver and Digestive Health University College London Hospitals, and University College London, London, United Kingdom. 5. Department of Surgery, Maastricht University Medical Centre and NUTRIM School of Nutrition and Translational Research, Maastricht University, Maastricht, The Netherlands; GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands. 6. Department of Surgery, Maastricht University Medical Centre and NUTRIM School of Nutrition and Translational Research, Maastricht University, Maastricht, The Netherlands; Department of Surgery, Royal Free & Institute for Liver and Digestive Health University College London Hospitals, and University College London, London, United Kingdom. Electronic address: steven.oldedamink@maastrichtuniversity.nl.
Abstract
INTRODUCTION: Postoperative liver failure (PLF) is a dreaded complication after partial hepatectomy. The peak bilirubin criterion (>7.0 mg/dL or ≥120 μmol/L) is used to define PLF. This study aimed to validate the peak bilirubin criterion as postoperative risk indicator for 90-day liver-related mortality. METHODS: Characteristics of 956 consecutive patients who underwent partial hepatectomy at the Maastricht University Medical Centre or Royal Free London between 2005 and 2012 were analyzed by uni- and multivariable analyses with odds ratios (OR) and 95% confidence intervals (95%CI). RESULTS: Thirty-five patients (3.7%) met the postoperative peak bilirubin criterion at median day 19 with a median bilirubin level of 183 [121-588] μmol/L. Sensitivity and specificity for liver-related mortality after major hepatectomy were 41.2% and 94.6%, respectively. The positive predictive value was 22.6%. Predictors of liver-related mortality were the peak bilirubin criterion (p < 0.001, OR = 15.9 [95%CI 5.2-48.7]), moderate-severe steatosis and fibrosis (p = 0.013, OR = 8.5 [95%CI 1.6-46.6]), ASA 3-4 (p = 0.047, OR = 3.0 [95%CI 1.0-8.8]) and age (p = 0.044, OR = 1.1 [95%CI 1.0-1.1]). CONCLUSION: The peak bilirubin criterion has a low sensitivity and positive predictive value for 90-day liver-related mortality after major hepatectomy.
INTRODUCTION:Postoperative liver failure (PLF) is a dreaded complication after partial hepatectomy. The peak bilirubin criterion (>7.0 mg/dL or ≥120 μmol/L) is used to define PLF. This study aimed to validate the peak bilirubin criterion as postoperative risk indicator for 90-day liver-related mortality. METHODS: Characteristics of 956 consecutive patients who underwent partial hepatectomy at the Maastricht University Medical Centre or Royal Free London between 2005 and 2012 were analyzed by uni- and multivariable analyses with odds ratios (OR) and 95% confidence intervals (95%CI). RESULTS: Thirty-five patients (3.7%) met the postoperative peak bilirubin criterion at median day 19 with a median bilirubin level of 183 [121-588] μmol/L. Sensitivity and specificity for liver-related mortality after major hepatectomy were 41.2% and 94.6%, respectively. The positive predictive value was 22.6%. Predictors of liver-related mortality were the peak bilirubin criterion (p < 0.001, OR = 15.9 [95%CI 5.2-48.7]), moderate-severe steatosis and fibrosis (p = 0.013, OR = 8.5 [95%CI 1.6-46.6]), ASA 3-4 (p = 0.047, OR = 3.0 [95%CI 1.0-8.8]) and age (p = 0.044, OR = 1.1 [95%CI 1.0-1.1]). CONCLUSION: The peak bilirubin criterion has a low sensitivity and positive predictive value for 90-day liver-related mortality after major hepatectomy.
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