Hepatic marker combination provides relevant score to predict severe morbidity after colorectal metastases-related major hepatectomy

A. Pontallier, C. Laurent, E. Buscail, F. Muscari, J. Adam, L. Chiche, S. Dabernat, V. Vendrely
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Abstract

Background and objectives: After hepatic resection, liver failure is not diagnosed until the postoperative day-5. The aim was to identify a biomarker predictive of severe morbidity, the day after major hepatectomy. Methods: This retrospective study included patients undergoing major hepatectomy for colorectal metastases, plasma hepatic marker concentrations being determined at postoperative day-one. Outcomes were 30-day severe morbidity (Dindo III to V) and grade C post-hepatectomy liver failure. Results: A total of 433 patients were included. Thirty-day severe morbidity, 90-day mortality and grade-C post-hepatectomy liver failure rates were 15.5%, 2.5% and 2.5% respectively. Using cut-offs determined by receiver operating characteristic curves the association of serum bilirubin ? 2.1 mg/dL (? 2 N) and aspartate-amino-transferase ? 450 IU/L (? 10 N) was selected for the best biochemical predictors of severe morbidity (sensitivity 38%, specificity 94%) and post-hepatectomy failure (sensitivity 100%, specificity 91%). In multivariate analysis, this score was independently associated with severe morbidity (HR = 5.98, 95% IC 2.65-13.89; P < 0.0001) Conclusions: The association of plasma bilirubin ? 2.1 mg/dL and aspartate-amino-transferase ? 450 IU/L is identified as a relevant predictor of severe morbidity and post-hepatectomy failure as early as the first postoperative day after major hepatectomy for colorectal metastases.
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肝标志物联合应用可为预测结直肠癌转移相关大肝切除术后的严重发病率提供相关评分
背景和目的:肝切除术后,直到术后第5天才诊断出肝功能衰竭。目的是确定一种生物标志物,预测主要肝切除术后一天的严重发病率。方法:这项回顾性研究纳入了因结肠直肠癌转移而接受大肝切除术的患者,在术后第一天测定血浆肝脏标志物浓度。结果是30天严重发病率(Dindo III至V)和肝切除术后C级肝衰竭。结果:共纳入433例患者。术后30天严重发病率、90天死亡率和c级肝衰竭发生率分别为15.5%、2.5%和2.5%。使用由受者工作特征曲线确定的截止值,血清胆红素?2.1 mg/dL (?2 N)和天冬氨酸氨基转移酶?450 iu / l (?选择10 N)作为严重发病率(敏感性38%,特异性94%)和肝切除术后失败(敏感性100%,特异性91%)的最佳生化预测指标。在多变量分析中,该评分与严重发病率独立相关(HR = 5.98, 95% IC 2.65-13.89;P < 0.0001)结论:血浆胆红素?2.1 mg/dL和天冬氨酸氨基转移酶?450iu /L被确定为严重发病率和肝切除术后失败的相关预测因子,早在结直肠癌大肝切除术后第一天。
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来源期刊
CiteScore
3.70
自引率
0.00%
发文量
5
审稿时长
20 weeks
期刊介绍: International Journal of Surgical Oncology is a peer-reviewed, Open Access journal that publishes original research articles, review articles, and clinical studies in all areas of surgical oncology.
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