Predicting risk of post-hepatectomy liver failure in patients undergoing liver resection with controlled low central venous pressure

Abstract

BACKGROUND

Post-hepatectomy liver failure (PHLF), represents a serious complication after liver resection, significantly impacting the long-term outcomes for patients who undergo such surgeries. There exists a strong correlation between intraoperative hemorrhage and transfusion requirements with the development of PHLF. Presently, a combination of hepatic portal occlusion techniques alongside controlled low central venous pressure (CLCVP) methodologies is extensively employed to mitigate intraoperative bleeding. Nonetheless, limited studies have analyzed the risk factors for PHLF under CLCVP.

AIM

To develop and validate a nomogram that predicts the risk factors associated with the development of PHLF patients undergoing liver resection with CLCVP.

METHODS

We conducted a retrospective analysis of 285 patients who underwent hepatectomy for the first time and had no history of prior non-index abdominal surgeries, with hepatic inflow occlusion combined with CLCVP from January to December 2019 in Hunan Provincial People’s Hospital. Univariate and multivariate regression analyses were used to identify preoperative and intraoperative risk factors for PHLF. Eligible patients were randomly divided into training and validation groups in a 7:3 ratio, and a nomogram prediction model was constructed.

RESULTS

The incidence of PHLF in these patients was 22.46%. Multiple logistic analysis showed that preoperative serum albumin level, causes of liver resection (cancer or others), and cirrhosis were independent preoperative risk factors for PHLF (P < 0.05) and that only post-blocking blood potassium concentration was an independent intraoperative risk factor for PHLF (P < 0.05). Least absolute shrinkage and selection operator regression analysis revealed that preoperative serum albumin level, direct bilirubin level (DBIL), platelet count, causes of liver resection (cancer or others), and cirrhosis were significant predictors of PHLF. The nomogram risk prediction model based on preoperative serum albumin level, DBIL, platelet count, causes of liver resection (cancer or others), cirrhosis and post-blocking blood potassium concentration can better predict the occurrence of PHLF.

CONCLUSION

For patients undergoing liver resection with CLCVP, serum albumin level, DBIL, platelet count, causes of liver resection (cancer or others), and cirrhosis are independent preoperative risk factors for PHLF.

Keywords: Post-hepatectomy liver failure; Controlled low central venous pressure; Risk factors; Hepatectomy; Liver resection

Core Tip: This is the first study to establish and validate a model for predicting the risk of post-hepatectomy liver failure (PHLF) in patients undergoing hepatectomy with controlled low central venous pressure. In this work, we determined that serum albumin level, direct bilirubin level, platelet count, causes of liver resection (cancer or others), and cirrhosis were the main preoperative risk factors associated with PHLF in patients undergoing hepatectomy with controlled low central venous pressure. There is no evidence showing that intraoperative variables other than post-blocking blood potassium concentration may affect PHLF in these patients. The predictive model established in this study holds significant potential for enhancing the identification and risk stratification of patients, thereby aiding in postoperative management and improving clinical outcomes.