Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Mar 16, 2021; 9(8): 1793-1802
Published online Mar 16, 2021. doi: 10.12998/wjcc.v9.i8.1793
Risk factors for post-hepatectomy liver failure in 80 patients
Ying Xing, Zheng-Rong Liu, Wei Yu, Hong-Yi Zhang, Mao-Min Song
Ying Xing, Zheng-Rong Liu, Wei Yu, Hong-Yi Zhang, Mao-Min Song, Department of General Surgery, Tiantan Hospital, Beijing 100170, China
Author contributions: Xing Y was involved in patient treatment, statistical analysis, writing of the original draft, and critical revision of the manuscript; Yu W took part in the statistical analysis; Liu ZR was involved in inpatient treatment; Zhang HY took part in the study conception, design, and critical revision of the manuscript; Song MM was involved in the study conception, design, writing of the original draft, and critical revision of the manuscript; all authors have read and approved the final manuscript.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee Approval Document of Tiantan Hospital, Institutional Review Board Approval No. KYSQ 2020-177-01.
Informed consent statement: All study participants provided written informed consent prior to study enrollment.
Conflict-of-interest statement: We do not have any patents, whether planned, pending or issued, broadly relevant to the work.
Data sharing statement: No additional data are available.
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: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Mao-Min Song, MD, Chief Doctor, Professor, Surgical Oncologist, Department of General Surgery, Tiantan Hospital, No. 119 Fanyang Street, Beijing 100170, China. chongshuyong@126.com
Received: September 19, 2020
Peer-review started: September 19, 2020
First decision: December 13, 2020
Revised: December 21, 2020
Accepted: December 27, 2020
Article in press: December 27, 2020
Published online: March 16, 2021
ARTICLE HIGHLIGHTS
Research background

Post-hepatectomy liver failure (PHLF) is the main cause of death after hepatectomy, which was first defined by the International Study Group of Liver Surgery in 2011. The incidence of PHLF ranges between 1.2%-32%.

Research motivation

Earlier studies showed that PHLF is related to many preoperative factors, the analysis of these factors can be helpful in the prevention of PHLF.

Research objectives

To analyze possible risk factors for PHLF in Chinese patients undergoing hepatectomy.

Research methods

Eighty patients who underwent partial hepatectomy for liver tumors from June 2018 to January 2020 were enrolled, they were divided into two groups according to whether PHLF occurred. Laboratory examination, Model for End-Stage Liver Disease score, albumin-bilirubin ratio, aspartate aminotransferase-to-platelet ratio index (APRI), spleen volume (SV), remnant liver volume, standard remnant liver volume ratio, and volume ratio of liver to spleen were compared and discussed.

Research results

Of 80 patients, 19 (23.75%) developed PHLF. Gender, history of hepatitis/cirrhosis, and preoperative bilirubin, albumin, coagulation function, albumin-bilirubin ratio, APRI, Model for End-Stage Liver Disease score, SV, spleen volume/liver volume ratio (SV/LV), and % remnant liver volume were statistically associated with the occurrence of PHLF according to univariate logistic regression analysis (all P < 0.05). Preoperative total bilirubin (TBIL), platelets (PLT), APRI, and SV/LV were independent risk factors for PHLF in multivariate regression analysis (all P < 0.05). The area under curve and cut-off values were 0.787 and 18.6 mmol/L for TBIL, 0.893 and 146 × 1012/L for PLT, the two cut-off values are consistent with the upper and lower limit of TBIL and PLT in our hospital; furthermore, area under curve and cut-off values were 0.907 and 0.416 for APRI, and 0.752 and 20.84% for SV/LV, respectively.

Research conclusions

Elevated preoperative total bilirubin, decreased PLT and APRI higher than 0.416, SV/LV higher than 20.85% are independent risk factors for PHLF in patients undergoing liver resection.

Research perspectives

The etiology of PHLF is unclear, and there is no standard method for predicting the occurrence of PHLF before surgery. More patients should be analyzed to obtain more precise data on the prediction of PHLF.