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

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.