1. Validation of the peak bilirubin criterion for outcome after partial hepatectomy.
- Author
-
van Mierlo KMC, Lodewick TM, Dhar DK, van Woerden V, Kurstjens R, Schaap FG, van Dam RM, Vyas S, Malagó M, Dejong CHC, and Olde Damink SWM
- Subjects
- Adult, Aged, Aged, 80 and over, Biomarkers blood, Female, Hepatectomy mortality, Humans, Liver Failure diagnosis, Liver Failure mortality, Logistic Models, London, Male, Middle Aged, Multivariate Analysis, Netherlands, Odds Ratio, Predictive Value of Tests, Reproducibility of Results, Retrospective Studies, Risk Factors, Time Factors, Treatment Outcome, Up-Regulation, Young Adult, Bilirubin blood, Hepatectomy adverse effects, Liver Failure blood
- Abstract
Introduction: Postoperative liver failure (PLF) is a dreaded complication after partial hepatectomy. The peak bilirubin criterion (>7.0 mg/dL or ≥120 μmol/L) is used to define PLF. This study aimed to validate the peak bilirubin criterion as postoperative risk indicator for 90-day liver-related mortality., Methods: Characteristics of 956 consecutive patients who underwent partial hepatectomy at the Maastricht University Medical Centre or Royal Free London between 2005 and 2012 were analyzed by uni- and multivariable analyses with odds ratios (OR) and 95% confidence intervals (95%CI)., Results: Thirty-five patients (3.7%) met the postoperative peak bilirubin criterion at median day 19 with a median bilirubin level of 183 [121-588] μmol/L. Sensitivity and specificity for liver-related mortality after major hepatectomy were 41.2% and 94.6%, respectively. The positive predictive value was 22.6%. Predictors of liver-related mortality were the peak bilirubin criterion (p < 0.001, OR = 15.9 [95%CI 5.2-48.7]), moderate-severe steatosis and fibrosis (p = 0.013, OR = 8.5 [95%CI 1.6-46.6]), ASA 3-4 (p = 0.047, OR = 3.0 [95%CI 1.0-8.8]) and age (p = 0.044, OR = 1.1 [95%CI 1.0-1.1])., Conclusion: The peak bilirubin criterion has a low sensitivity and positive predictive value for 90-day liver-related mortality after major hepatectomy., (Copyright © 2016 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.)
- Published
- 2016
- Full Text
- View/download PDF