99mTc-GSA scintigraphy and modified albumin-bilirubin score can be complementary to ICG for predicting posthepatectomy liver failure.

IF 1.6 3区医学 Q2 SURGERY BMC Surgery Pub Date : 2024-11-01 DOI:10.1186/s12893-024-02624-8

Satoshi Mii, Takeshi Takahara, Susumu Shibasaki, Takuma Ishihara, Takuya Mizumoto, Yuichiro Uchida, Hideaki Iwama, Masayuki Kojima, Yutaro Kato, Koichi Suda

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Abstract

Background: Posthepatectomy liver failure (PHLF) remains a severe complication after liver resection. This retrospective study investigated the correlation of three hepatic functional tests and whether 99mTc-galactosyl human serum albumin (99mTc-GSA) scintigraphy and modified albumin-bilirubin (ALBI) score are useful for predicting PHLF.

Methods: This retrospective cohort study included 413 consecutive patients undergoing hepatectomies between January 2017 and December 2020. To evaluate preoperative hepatic functional reserve, modified ALBI grade, indocyanine green clearance (ICG-R15), and 99mTc-GSA scintigraphy (LHL15) were examined before scheduled hepatectomy. Based on a retrospective chart review, multivariable logistic regression analysis adjusted for confounding factors was performed to confirm that mALBI, ICG-R15, and LHL15 are independent risk factors for PHLF.

Results: ICG-R15 and LHL15 were moderately correlated (r = - 0.61) but this correlation weakened when ICG-R15 was about ≥ 20. Weak correlations were observed between LHL15 and ALBI score (r = - 0.269) and ALBI score and ICG-R15 (r = 0.339). Of 413 patients, 66 (19%) developed PHLF (20 grade A, 44 grade B, 2 grade C). Multivariable logistic regression analyses, major hepatectomy (P < 0.001), mALBI grade (P = 0.01), ICG-R15 (P < 0.001), and Esophagogastric varices (P = 0.007) were significant independent risk factors for PHLF. Subgroup analysis showed that ICG-R15 < 19, major hepatectomy, and mALBI grade and ICG-R15 ≥ 19, major hepatectomy, LHL15, and Esophagogastric varices were significant independent risk factors for PHLF (P = 0.033, 0.017, 0.02, 0.02, and 0.001, respectively).

Conclusion: LHL15, the assessment of Esophagogastric varices, and mALBI grade are complementary to ICG-R15 for predicting PHLF risk.

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在预测肝切除术后肝功能衰竭方面，99m锝-GSA闪烁扫描和改良白蛋白-胆红素评分可与ICG互为补充。

背景：肝切除术后肝衰竭（PHLF肝切除术后肝功能衰竭（PHLF）仍是肝切除术后的一种严重并发症。这项回顾性研究调查了三种肝功能检测的相关性，以及99m锝-半乳糖基人血清白蛋白（99m锝-GSA）闪烁扫描和改良白蛋白-胆红素（ALBI）评分是否有助于预测PHLF：这项回顾性队列研究纳入了2017年1月至2020年12月期间接受肝切除术的413例连续患者。为评估术前肝功能储备，在预定的肝切除术前检查了改良的ALBI分级、吲哚青绿清除率（ICG-R15）和99m锝-GSA闪烁成像（LHL15）。在回顾性病历审查的基础上，对混杂因素进行了多变量逻辑回归分析，以证实mALBI、ICG-R15和LHL15是PHLF的独立风险因素：ICG-R15和LHL15呈中度相关（r = - 0.61），但当ICG-R15约≥20时，这种相关性减弱。在 LHL15 和 ALBI 评分（r = - 0.269）以及 ALBI 评分和 ICG-R15 （r = 0.339）之间观察到较弱的相关性。在 413 例患者中，66 例（19%）发展为 PHLF（20 例 A 级，44 例 B 级，2 例 C 级）。多变量逻辑回归分析、肝大部切除术（P 结论：肝大部切除术是一种有效的肝脏切除术：LHL15、食管胃静脉曲张评估和 mALBI 分级是 ICG-R15 预测 PHLF 风险的补充。

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