Bobby V M Dasari1, James Hodson2, Keith J Roberts3, Robert P Sutcliffe3, Ravi Marudanayagam3, Darius F Mirza3, John Isaac3, Paolo Muiesan3. 1. Dept of HPB Surgery, Queen Elizabeth Hospital, Birmingham B15 2WB, United Kingdom. Electronic address: bobby.dasari@yahoo.com. 2. Institute of Translational Medicine, Queen Elizabeth Hospital Birmingham, Birmingham B15 2TH, United Kingdom. 3. Dept of HPB Surgery, Queen Elizabeth Hospital, Birmingham B15 2WB, United Kingdom.
Abstract
BACKGROUND: Post hepatectomy liver failure (PHLF) is a serious complication in patients undergoing liver resection. This study hypothesized that a new pre-operative risk score developed through statistical modeling to predict PHLF could be used to stratify patients at higher risk of PHLF. METHODS: Patients who underwent hepatectomy between 2008 and 2016 were included in the derivation and validation cohorts. A multivariable binary logistic regression model was performed to identify predictors of PHLF, and a prognostic score was derived. RESULTS: A total of 1269 patients were included in the derivation cohort. PHLF was encountered in 13.1% and was associated with significantly increased 90-day mortality and prolonged post-operative hospital stay (both p < 0.001). Multivariable analysis identified the extent of surgery (p < 0.001) and pre-operative bilirubin (p = 0.015), INR (p < 0.001), and creatinine (p = 0.048) to be independent predictors of PHLF. A risk score derived from these factors returned an area under the ROC curve (AUROC) of 0.816 (p < 0.001) for an internal validation cohort (N = 453), significantly outperforming the MELD score (AUROC: 0.643). CONCLUSION: The PHLF risk score could be used to stratify the risk of PHLF among patients planned for hepatectomy.
BACKGROUND: Post hepatectomy liver failure (PHLF) is a serious complication in patients undergoing liver resection. This study hypothesized that a new pre-operative risk score developed through statistical modeling to predict PHLF could be used to stratify patients at higher risk of PHLF. METHODS:Patients who underwent hepatectomy between 2008 and 2016 were included in the derivation and validation cohorts. A multivariable binary logistic regression model was performed to identify predictors of PHLF, and a prognostic score was derived. RESULTS: A total of 1269 patients were included in the derivation cohort. PHLF was encountered in 13.1% and was associated with significantly increased 90-day mortality and prolonged post-operative hospital stay (both p < 0.001). Multivariable analysis identified the extent of surgery (p < 0.001) and pre-operative bilirubin (p = 0.015), INR (p < 0.001), and creatinine (p = 0.048) to be independent predictors of PHLF. A risk score derived from these factors returned an area under the ROC curve (AUROC) of 0.816 (p < 0.001) for an internal validation cohort (N = 453), significantly outperforming the MELD score (AUROC: 0.643). CONCLUSION: The PHLF risk score could be used to stratify the risk of PHLF among patients planned for hepatectomy.
Authors: Lily V Saadat; Debra A Goldman; Mithat Gonen; Kevin C Soares; Alice C Wei; Vinod P Balachandran; T Peter Kingham; Jeffrey Drebin; William R Jarnagin; Michael I D'Angelica Journal: J Am Coll Surg Date: 2021-05-21 Impact factor: 6.532