The "50-50 criteria" on postoperative day 5 - An accurate predictor of liver failure and death after hepatectomy
The "50-50 criteria" on postoperative day 5 - An accurate predictor of liver failure and death after hepatectomy
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DOI：
10.1097/01.sla.0000189131.90876.9e
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发表时间：
2005-12-01
影响因子：
9
通讯作者：
Durand, F
中科院分区：
文献类型：
--
作者：
Balzan, S;Belghiti, J;Durand, F
目的：标准化术后肝衰竭（PLF）的定义，以预测肝切除术后早期死亡率。背景资料摘要：PLF 的定义不标准化，使得手术技术创新的比较和特定治疗干预措施的及时使用变得复杂。方法：1998 年至 2002 年间，775 例择期肝切除术，其中 69% 为恶性肿瘤，60% 为重大疾病 切除术，被纳入前瞻性数据库中。 43% 的非肿瘤肝脏异常，14% 的脂肪变性> 30%，43% 的非肝硬化纤维化，12% 的肝硬化。分析凝血酶原时间(PT) < 50%和血清胆红素(SB) > 50 μmol/L对术后第1、3、5、7天的影响。结果：术后第1天(POD)观察到PT水平最低，而术后第3天观察到SB峰值。这2个变量在术后第5天有恢复到术前值的趋势。 肝切除术与术后死亡之间的中位间隔为 15 天（范围为 5-39 天）。 PT<50%且SB>50μml/L的患者术后死亡率显着增加。 POD 5 上PT<50%和SB>50μmol/L的结合为a．死亡率的强预测因素。对于发病率较高的患者，在出现并发症的临床证据之前 3 至 8 天就满足了这一“50-50 标准”。 结论：PT < 50% 和 SB > 50 μmol/L 与 POD 5 的关联（50-50 标准）是肝切除术后死亡率超过 50% 的简单、早期且准确的预测因子。在出现并发症的临床证据之前，可以尽早确定这一标准，以便及时采取具体干预措施。
Objective: To standardize the definition of postoperative liver failure (PLF) for prediction of early mortality after hepatectomy.Summary Background Data: The definition of PLF is not standardized, making the comparison of innovations in surgical techniques and the timely use of specific therapeutic interventions complex.Methods: Between 1998 and 2002, 775 elective liver resections, including 69% for malignancies and 60% major resections, were included in a prospective database. The nontumorous liver was abnormal in 43% with steatosis > 30% in 14%, noncirrhotic fibrosis in 43%, and cirrhosis in 12%. The impact of prothrombin time (PT) < 50% and serum bilirubin (SB) > 50 mu mol/L on postoperative days (POD) 1, 3, 5, and 7 was analyzed.Results: The lowest PT level was observed on postoperative day (POD) 1, while the peak of SB was observed on POD 3. These 2 variables tended to return to preoperative values by POD 5. The median interval between hepatectomy and postoperative death was 15 days (range, 5-39 days). Postoperative mortality significantly increased in patients with PT < 50% and SB > 50 mu ml/L. The conjunction of PT < 50% and SB > 50 mu mol/L on POD 5 was a. strong predictive factor of mortality. In patients with significant morbidity, this "50-50 criteria" was met 3 to 8 days before clinical evidence of complications.Conclusions: The association of PT < 50% and SB > 50 mu mol/L on POD 5 (the 50-50 criteria) was a simple, early, and accurate predictor of more than 50% mortality rate after hepatectomy. This criteria could be identified early enough, before clinical evidence of complications, for specific interventions to be applied in due time.