TY - JOUR
T1 - Prognostic criteria for postoperative mortality in 170 patients undergoing major right hepatectomy
AU - Filicori, Filippo
AU - Keutgen, Xavier M.
AU - Zanello, Matteo
AU - Ercolani, Giorgio
AU - Di Saverio, Salomone
AU - Sacchetti, Federico
AU - Daniele, Antonio Pinna
AU - Grazi, Gian Luca
PY - 2012
Y1 - 2012
N2 - Background: Postoperative hepatic failure is a dreadful complication after major hepatectomy and carries high morbidity and mortality rates. In this study, we assessed the accuracy of the 50/50 criteria (bilirubin >2.9 mg/dL and international normalized ratio >1.7 on postoperative day 5) and the Mullen criteria (bilirubin peak >7 mg/dL on postoperative days 1-7) in predicting death from hepatic failure in patients undergoing right hepatectomy only. In addition, we identified prognostic factors linked to intra-hospital morbidity and mortality in these patients. Methods: One hundred seventy consecutive patients underwent major right hepatectomy at a tertiary medical center from 2000 to 2008. Nineteen (11.2%) patients suffered from liver cirrhosis. Univariate and multivariate analyses were performed to identify predictors of intra-hospital mortality, morbidity and death from hepatic failure. Results: The intra-hospital mortality was 6.5% (11/170). Of the six patients who died from hepatic failure, one was positive for the 50/50 criteria, but all six patients were positive for the Mullen criteria. Multivariate analysis showed that male gender, hepatitis C (HCV), hepatocellular carcinoma, postoperative bilirubin >7 mg/dL and ALT65 years, HCV, reoperation, and renal failure were significant predictors of overall intrahospital mortality on multivariate analysis. Conclusions: The Mullen criteria were more accurate than the 50/50 criteria in predicting death from hepatic failure in patients undergoing right hepatectomy. A bilirubin peak >7 mg/dL in the postoperative period, HCV positivity, hepatocellular carcinoma, and an ALT level
AB - Background: Postoperative hepatic failure is a dreadful complication after major hepatectomy and carries high morbidity and mortality rates. In this study, we assessed the accuracy of the 50/50 criteria (bilirubin >2.9 mg/dL and international normalized ratio >1.7 on postoperative day 5) and the Mullen criteria (bilirubin peak >7 mg/dL on postoperative days 1-7) in predicting death from hepatic failure in patients undergoing right hepatectomy only. In addition, we identified prognostic factors linked to intra-hospital morbidity and mortality in these patients. Methods: One hundred seventy consecutive patients underwent major right hepatectomy at a tertiary medical center from 2000 to 2008. Nineteen (11.2%) patients suffered from liver cirrhosis. Univariate and multivariate analyses were performed to identify predictors of intra-hospital mortality, morbidity and death from hepatic failure. Results: The intra-hospital mortality was 6.5% (11/170). Of the six patients who died from hepatic failure, one was positive for the 50/50 criteria, but all six patients were positive for the Mullen criteria. Multivariate analysis showed that male gender, hepatitis C (HCV), hepatocellular carcinoma, postoperative bilirubin >7 mg/dL and ALT65 years, HCV, reoperation, and renal failure were significant predictors of overall intrahospital mortality on multivariate analysis. Conclusions: The Mullen criteria were more accurate than the 50/50 criteria in predicting death from hepatic failure in patients undergoing right hepatectomy. A bilirubin peak >7 mg/dL in the postoperative period, HCV positivity, hepatocellular carcinoma, and an ALT level
KW - Bilirubin
KW - Hepatectomy
KW - Liver diseases
KW - Liver failure
KW - Postoperative complications
KW - Prothrombin time
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U2 - 10.1016/S1499-3872(12)60215-X
DO - 10.1016/S1499-3872(12)60215-X
M3 - Article
C2 - 23060396
AN - SCOPUS:84867793936
VL - 11
SP - 507
EP - 512
JO - Hepatobiliary and Pancreatic Diseases International
JF - Hepatobiliary and Pancreatic Diseases International
SN - 1499-3872
IS - 5
ER -