Perioperative Changes in Serum Transaminase Levels: Impact on Postoperative Morbidity After Liver Resection of Hepatocellular Carcinoma.

IF 7.5 1区 医学 Q1 SURGERY Annals of surgery Pub Date : 2025-04-01 Epub Date: 2024-02-13 DOI:10.1097/SLA.0000000000006235
Fumin Wang, Jingming Lu, Tian Yang, Yaoxing Ren, Francesca Ratti, Hugo P Marques, Silvia Silva, Olivier Soubrane, Vincent Lam, George A Poultsides, Irinel Popescu, Razvan Grigorie, Sorin Alexandrescu, Guillaume Martel, Aklile Workneh, Alfredo Guglielmi, Tom Hugh, Luca Aldrighetti, Itaru Endo, Yi Lv, Xu-Feng Zhang, Timothy M Pawlik
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Abstract

Objectives: To define how dynamic changes in pre versus postoperative serum aspartate aminotransferase (AST) and alanine transaminase (ALT) levels may impact postoperative morbidity after curative-intent resection of hepatocellular carcinoma (HCC).

Background: Hepatic ischemia/reperfusion can occur at the time of liver resection and may be associated with adverse outcomes after liver resection.

Methods: Patients who underwent curative resection for HCC between 2010 and 2020 were identified from an international multi-institutional database. Changes in AST and ALT (CAA) on postoperative day 3 versus preoperative values ( ) were calculated using the formula: based on a fusion index through the Euclidean norm, which was examined relative to the Comprehensive Complication Index (CCI). The impact of CAA on CCI was assessed by the restricted cubic spline regression and Random Forest analyses.

Results: A total of 759 patients were included in the analytic cohort. Median CAA was 1.7 (range: 0.9-3.25); 431 (56.8%) patients had a CAA <2 215 (28.3%) patients with CAA 2 to 5, and 113 (14.9%) patients had CAA ≥5. The incidence of postoperative complications was 65.0% (n = 493) with a median CCI of 20.9 (interquartile range: 20.9-33.5). Spline regression analysis demonstrated a nonlinear incremental association between CAA and CCI. The optimal cutoff value of CAA was 5, identified by the recursive partitioning technique. After adjusting for other competing risk factors, CAA ≥5 remained strongly associated with the risk of postoperative complications (reference CAA <5, odds ratio: 1.63, 95% CI: 1.05-2.55, P = 0.03). In fact, the use of CAA to predict postoperative complications was very good in both the derivative (area under the curve: 0.88) and external (area under curve: 0.86) cohorts (n = 1137).

Conclusions: CAA was an independent predictor of CCI after liver resection for HCC. The use of routine laboratories, such as AST and ALT, can help identify patients at the highest risk of postoperative complications after HCC resection.

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围手术期血清转氨酶水平的变化:肝细胞癌肝脏切除术后发病率的影响。
目的明确术前与术后血清天冬氨酸转氨酶(AST)和丙氨酸转氨酶(ALT)水平的动态变化如何影响肝细胞癌(HCC)根治性切除术后的发病率:背景:肝脏切除术时可能会出现肝脏缺血/再灌注,这可能与肝脏切除术后的不良预后有关:方法:从国际多机构数据库中筛选出 2010-2020 年间接受 HCC 根治性切除术的患者。术后第 3 天(POD)的谷草转氨酶(AST)和谷丙转氨酶(ALT)(CAA)相对于术前值()的变化,计算公式为:基于欧氏常模的融合指数,与综合并发症指数(CCI)相对照。通过限制性三次样条回归和随机森林分析评估了 CAA 对 CCI 的影响:共有 759 名患者被纳入分析队列。中位 CAA 为 1.7(范围为 0.9 至 3.25);431 例(56.8%)患者有 CAAC 结论:CAA 是 CCI 的独立预测因子:CAA是预测HCC肝切除术后CCI的独立指标。使用 AST 和 ALT 等常规实验室检查有助于确定 HCC 切除术后并发症风险最高的患者。
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来源期刊
Annals of surgery
Annals of surgery 医学-外科
CiteScore
14.40
自引率
4.40%
发文量
687
审稿时长
4 months
期刊介绍: The Annals of Surgery is a renowned surgery journal, recognized globally for its extensive scholarly references. It serves as a valuable resource for the international medical community by disseminating knowledge regarding important developments in surgical science and practice. Surgeons regularly turn to the Annals of Surgery to stay updated on innovative practices and techniques. The journal also offers special editorial features such as "Advances in Surgical Technique," offering timely coverage of ongoing clinical issues. Additionally, the journal publishes monthly review articles that address the latest concerns in surgical practice.
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