Prospective Validation of the "Fifty-Fifty" Criteria as an Early and Accurate Predictor of Death After Liver Resection in Intensive Care Unit Patients
Prospective Validation of the "Fifty-Fifty" Criteria as an Early and Accurate Predictor of Death After Liver Resection in Intensive Care Unit Patients
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DOI：
10.1097/sla.0b013e31819279cd
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发表时间：
2009-01-01
影响因子：
9
通讯作者：
Belghiti, Jacques
中科院分区：
文献类型：
--
作者：
Paugam-Burtz, Catherine;Janny, Sylvie;Belghiti, Jacques
背景：肝切除术后肝功能衰竭已通过凝血酶原时间50 μ mol/L（“50-50”标准）的相关性来确定。这些标准在前瞻性研究中是否具有预后价值尚不清楚。目的：探讨50-50标准在重症监护病房（ICU）肝切除术后第3天和第5天的预后价值。方法：2005年1月至2007年2月，我院择期肝切除术436例，术后连续住院患者99例（23%），年龄58 +/- 17岁，平均SAPSII 25 +/- 10。恶性疾病在87例和主要切除术中出现（分别为19例、23例和17例，占30%）。结果：10例患者在第3天达到50-50标准，13例患者在第5天达到50-50标准。10例（10.6%）患者在ICU死亡。符合这些标准的幸存者接受早期积极支持，包括再手术和/或肝辅助系统。非幸存者更常发生肝硬化，SAPS显著增高，术后延长机械通气时间更频繁。多变量分析显示，第3天和第5天的50-50标准是死亡的预测因子[OR (95% CI): 12.7 (2.3-71.4) OR (95% CI): 29.4(4.9-167)]。结论：肝切除术后，这项前瞻性研究的结果验证了50-50标准作为ICU第3天和第5天死亡率的预测因素。这些标准允许早期诊断术后肝功能衰竭，这可能有助于降低ICU患者肝切除术后的死亡率。
Background: Postoperative liver failure after hepatectomy has been identified by the association of prothrombin time 50 mu mol/L (the "50-50" criteria). Whether these criteria are of prognostic value in a prospective study remains unknown.Objective: To determine prospectively the prognostic value of the 50-50 criteria on day 3 and day 5 in intensive care unit (ICU) patients after hepatectomy.Methods: From January 2005 to February 2007, among 436 elective liver resections, 99 (23%) consecutive patients aged 58 +/- 17 years were admitted postoperatively in ICU with a mean SAPSII 25 +/- 10. Malignant disease was present in 87 and major resections (30% in 19, 23, and 17 patients, respectively.Results: The 50-50 criteria were present on day 3 in 10 patients and on day 5 in 13. Ten patients (10, 6%) died in ICU. Survivors with these criteria were characterized by early aggressive support including reoperation and/or liver assist system. Nonsurvivors were more often cirrhotic, had significantly higher SAPS If and more frequently postoperative prolonged mechanical ventilation. The 50-50 criteria on days 3 and 5 were predictors, of death on multivariate analysis [OR (95% CI): 12.7 (2.3-71.4) OR (95% CI): 29.4 (4.9-167), respectively].Conclusions: After hepatic resection, results of this prospective study validate the 50-50 criteria as a predictive factor of mortality in ICU on both days 3 and 5. These criteria allow an early diagnosis of postoperative liver failure, which may contribute to reduce mortality in ICU patients after hepatectomy.