Combining ALT/AST Values with Surgical APGAR Score Improves Prediction of Major Complications after Hepatectomy.
Combining ALT/AST Values with Surgical APGAR Score Improves Prediction of Major Complications after Hepatectomy.
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DOI：
10.26502/jsr.10020179
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发表时间：
2021
期刊：
影响因子：
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通讯作者：
Singh I
中科院分区：
文献类型：
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作者：
Mitsiev I;Rubio K;Ranvir VP;Yu D;Palanisamy AP;Chavin KD;Singh I
肝切除术是一种复杂的手术，具有较高的发病率和死亡率。早期预测/预防主要并发症对患者护理非常有价值。手术APGAR评分（SAS）已被证实可预测术后并发症（PC）。我们的目的是根据治疗导向的严重程度Clavien-Dindo分类（CDC）定义一个简单的肝切除术后并发症分类。纳入了119例接受肝切除术的患者。在随访时根据CDC确定PC。采用临床病理因素计算SAS。受试者-操作者特征（ROC）曲线分析估计了SAS对PC的预测价值。肝损伤的循环标志物水平作为PC上的关键要素进行分析。SAS（P=0.008）、估计失血量（P=0.018）和手术时间（P=0.0008）与PC相关。与无（−）并发症的患者相比，（+）并发症患者的SAS降低（6.64±1.84 vs 5.70±1.79，P=0.0079）。ROC曲线下面积为0.646，表明区分（-）和（+）组的可能性为65%（P=0.004）。SAS的最佳临界值为≤6/≥7，此时敏感性和特异性最高。SAS评分为9-10分组间ALT/ASL水平差异有统计学意义（P=0.01和0.02）。总之，SAS为肝切除术后的主要PC提供了准确的风险分层，并可能有助于改善患者的总体预后。
Hepatectomy is a complex procedure with high morbidity and mortality. Early prediction/prevention of major complications is highly valuable for patient care. Surgical APGAR score (SAS) has been validated to predict post-surgical complications (PCs). We aimed to define a simple complications classification following hepatectomy based on a therapy-oriented severity Clavien-Dindo classification (CDC). 119 patients undergoing liver resection were included. PCs were determined at follow-up based on CDC. Clinicopathological factors were used to calculate SAS. A receiver-operator characteristic (ROC) curve analysis estimated the predictive value of SAS for PCs. Circulating markers levels of liver injury were analyzed as critical elements on PCs. SAS (P=0.008), estimated blood-loss (P=0.018) and operation time (P=0.0008) were associated with PCs. SAS was reduced in patients with (+) compared to those without (−) complications (6.64±1.84 vs 5.70±1.79, P=0.0079). The area-under-the-curve was 0.646 by ROC, indicating an acceptable discrimination with 65% possibility to distinguish (−) and (+) groups (P=0.004). Best cutoff value for SAS was ≤6/≥7, at which sensitivity and specificity were maximal. ALT/ASL levels were significantly different within the group with 9-10 SAS points (P=0.01 and 0.02). In conclusion, SAS provides accurate risk stratification for major PCs after hepatectomy, and might help improving the overall patient outcome.