Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 14, 2024; 30(22): 2881-2892
Published online Jun 14, 2024. doi: 10.3748/wjg.v30.i22.2881
Heparin is an effective treatment for preventing liver failure after hepatectomy
Zhi-Ying Xu, Min Peng, Ming-Ming Fan, Qi-Fei Zou, Yi-Ran Li, Dong Jiang
Zhi-Ying Xu, Ming-Ming Fan, Qi-Fei Zou, Hepatic Surgery IV, Shanghai Eastern Hepatobiliary Surgery Hospital, The Third Affiliated Hospital of Naval Medical University, Shanghai 200433, China
Min Peng, Ultrasound Diagnosis, PLA Naval Medical Center, Shanghai 200437, China
Yi-Ran Li, Dong Jiang, Department of Ultrasound, Eastern Hepatobiliary Surgery Hospital, The Third Affiliated Hospital of Naval Medical University, Shanghai 200433, China
Co-first authors: Zhi-Ying Xu and Min Peng.
Co-corresponding authors: Yi-Ran Li and Dong Jiang.
Author contributions: Xu ZY and Peng M contributed equally to the study; Li YR contributed to conception and design of the research; Zou QF and Jiang D contributed to acquisition of data; Xu ZY and Peng M contributed to analysis and interpretation of data; Fan MM contributed to statistical analysis; Xu ZY contributed to drafting the manuscript; Li YR and Peng M contributed to revision of manuscript for important intellectual content. Li YR and Jiang D should be considered as co-corresponding authors because of their significant contributions throughout the research; Li YR was responsible for the overall research direction, experimental design, and manuscript preparation, ensuring the study’s scientific integrity and quality; Jiang D contributed crucially to the acquisition of data and provided essential support during the analysis phase; both authors played critical roles that made them integral to the successful completion of this study.
Supported by the National Natural Science Foundation of China Youth Training Project, No. 2021GZR003; and Medical-engineering Interdisciplinary Research Youth Training Project, No. 2022YGJC001.
Institutional review board statement: Data for this study were sourced from version 1.4 of the Multiparameter Intelligent Monitoring in Intensive Care III (MIMIC-III) database. MIMIC-III, which is freely accessible, contains records for over 50,000 critical care patients who were treated at Beth Israel Deaconess Medical Center between 2001 and 2012. Prior to accessing the database, completion of the “Protecting Human Research Participants” course offered by the National Institutes of Health was mandatory (record ID: 11186516). Both the Massachusetts Institute of Technology and Beth Israel Deaconess Medical Center’s Institutional Review Boards approved the use and creation of this database.
Informed consent statement: Data for this study were sourced from version 1.4 of the Multiparameter Intelligent Monitoring in Intensive Care III (MIMIC-III) database. The need for informed consent was waived due to the de-identification of all data.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
Data sharing statement: The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Dong Jiang, MMed, Master’s Student, Department of Ultrasound, Eastern Hepatobiliary Surgery Hospital, The Third Affiliated Hospital of Naval Medical University, No. 201 Changhai Road, Shanghai 200433, China. jiangdong2002317@aliyun.com
Received: March 5, 2024
Revised: April 26, 2024
Accepted: May 20, 2024
Published online: June 14, 2024
Processing time: 92 Days and 20.3 Hours
Abstract
BACKGROUND

Posthepatectomy liver failure (PHLF) is one of the most important causes of death following liver resection. Heparin, an established anticoagulant, can protect liver function through a number of mechanisms, and thus, prevent liver failure.

AIM

To look at the safety and efficacy of heparin in preventing hepatic dysfunction after hepatectomy.

METHODS

The data was extracted from Multiparameter Intelligent Monitoring in Intensive Care III (MIMIC-III) v1. 4 pinpointed patients who had undergone hepatectomy for liver cancer, subdividing them into two cohorts: Those who were injected with heparin and those who were not. The statistical evaluations used were unpaired t-tests, Mann-Whitney U tests, chi-square tests, and Fisher’s exact tests to assess the effect of heparin administration on PHLF, duration of intensive care unit (ICU) stay, need for mechanical ventilation, use of continuous renal replacement therapy (CRRT), incidence of hypoxemia, development of acute kidney injury, and ICU mortality. Logistic regression was utilized to analyze the factors related to PHLF, with propensity score matching (PSM) aiming to balance the preoperative disparities between the two groups.

RESULTS

In this study, 1388 patients who underwent liver cancer hepatectomy were analyzed. PSM yielded 213 matched pairs from the heparin-treated and control groups. Initial univariate analyses indicated that heparin potentially reduces the risk of PHLF in both matched and unmatched samples. Further analysis in the matched cohorts confirmed a significant association, with heparin reducing the risk of PHLF (odds ratio: 0.518; 95% confidence interval: 0.295-0.910; P = 0.022). Additionally, heparin treatment correlated with improved short-term postoperative outcomes such as reduced ICU stay durations, diminished requirements for respiratory support and CRRT, and lower incidences of hypoxemia and ICU mortality.

CONCLUSION

Liver failure is an important hazard following hepatic surgery. During ICU care heparin administration has been proved to decrease the occurrence of hepatectomy induced liver failure. This indicates that heparin may provide a hopeful option for controlling PHLF.

Keywords: Liver resection; Posthepatectomy liver failure; Prophylactic treatment; Heparin; Prognosis of hepatectomy

Core Tip: This study emphasizes that heparin, which is commonly identified with its anticoagulant characteristics, also offers benefits in prevention of posthepatectomy liver failure (PHLF). Application of the Multiparameter Intelligent Monitoring in Intensive Care III database shows that the administration of heparin in the postoperative intensive care unit (ICU) setting is linked to a decreased occurrence of PHLF, shortened ICU stays, and lesser need for mechanical ventilation and renal support. These outcomes underscore heparin’s potential as a valuable therapeutic option to enhance short-term postoperative results for patients undergoing liver surgery.