Background: Post hepatectomy liver failure (PHLF) is a serious complication in patients undergoing liver resection. This study hypothesized that a new pre-operative risk score developed through statistical modeling to predict PHLF could be used to stratify patients at higher risk of PHLF. Methods: Patients who underwent hepatectomy between 2008 and 2016 were included in the derivation and validation cohorts. A multivariable binary logistic regression model was performed to identify predictors of PHLF, and a prognostic score was derived. Results: A total of 1269 patients were included in the derivation cohort. PHLF was encountered in 13.1% and was associated with significantly increased 90-day mortality and prolonged post-operative hospital stay (both p < 0.001). Multivariable analysis identified the extent of surgery (p < 0.001) and pre-operative bilirubin (p = 0.015), INR (p < 0.001), and creatinine (p = 0.048) to be independent predictors of PHLF. A risk score derived from these factors returned an area under the ROC curve (AUROC) of 0.816 (p < 0.001) for an internal validation cohort (N = 453), significantly outperforming the MELD score (AUROC: 0.643). Conclusion: The PHLF risk score could be used to stratify the risk of PHLF among patients planned for hepatectomy.

Developing and validating a pre-operative risk score to predict post-hepatectomy liver failure / B.V.M. Dasari, J. Hodson, K.J. Roberts, R.P. Sutcliffe, R. Marudanayagam, D.F. Mirza, J. Isaac, P. Muiesan. - In: HPB. - ISSN 1365-182X. - 21:5(2019), pp. 539-546. [10.1016/j.hpb.2018.09.011]

Developing and validating a pre-operative risk score to predict post-hepatectomy liver failure

P. Muiesan
Ultimo
2019

Abstract

Background: Post hepatectomy liver failure (PHLF) is a serious complication in patients undergoing liver resection. This study hypothesized that a new pre-operative risk score developed through statistical modeling to predict PHLF could be used to stratify patients at higher risk of PHLF. Methods: Patients who underwent hepatectomy between 2008 and 2016 were included in the derivation and validation cohorts. A multivariable binary logistic regression model was performed to identify predictors of PHLF, and a prognostic score was derived. Results: A total of 1269 patients were included in the derivation cohort. PHLF was encountered in 13.1% and was associated with significantly increased 90-day mortality and prolonged post-operative hospital stay (both p < 0.001). Multivariable analysis identified the extent of surgery (p < 0.001) and pre-operative bilirubin (p = 0.015), INR (p < 0.001), and creatinine (p = 0.048) to be independent predictors of PHLF. A risk score derived from these factors returned an area under the ROC curve (AUROC) of 0.816 (p < 0.001) for an internal validation cohort (N = 453), significantly outperforming the MELD score (AUROC: 0.643). Conclusion: The PHLF risk score could be used to stratify the risk of PHLF among patients planned for hepatectomy.
Aged; Biomarkers; Female; Humans; Liver Failure; Liver Function Tests; Male; Middle Aged; Postoperative Complications; Predictive Value of Tests; Preoperative Period; Retrospective Studies; Risk Assessment; Hepatectomy
Settore MED/18 - Chirurgia Generale
HPB
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2434/883556
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