Early identification of patients at increased risk of liver failure, postoperative complications and death after major hepatectomy

Introduction: Aim of this study was to identify early predictive markers of clinically significant liver failure (PHLF B/C), postoperative complications and mortality after major liver resections. Materials and methods: 115 consecutive major hepatectomies (three or more segments) were carried out and retrospectively analyzed. Association beetween PHLF, major complications, in-hospital mortality, demographics, clinical-pathologic and perioperative factors was evaluated. Multivariate logistic regression analysis was used to develop a predictive model for PHLF B/C, Clavien-Dindo grades III-V complications and mortality. Sensitivity, specificity and the area under the receiver operating characteristic (AUROC) curve were assessed. Results: PHLF B/C was observed in 25 of 115 (21.7%) patients. 41 (35.7%) developed major complications, in-hospital mortality was 3.5% (4 patients). Multivariate logistic regression analysis identified high serum bilirubin and increased prothrombin time (PT) ratio on postoperative day 3 (POD3) as indipendent predictive markers of PHLF B/C (P < 0.05). POD3 high serum bilirubin was the only early postoperative factor influencing the risk of major complications (P < 0.05) and in-hospital death (P < 0.001) on multivariate analysis. ROC curve analysis of PT ratio (AUC 0.775) and serum bilirubin (AUC 0.813) on POD3 showed respectively 73% and 83% sensivity and 27% and 28% specificity at a threshold of 1.35 and 1.75 mg/dL. Conclusions: Rising of serum bilirubin and PT ratio early after hepatectomy appears strongly predictive of PHLF B/C. Compared to other studies, our threshold value of serum bilirubin was slightly lower with a higher sensitivity. POD3 high serum bilirubin was the only factor influencing in-hospital mortality and major complication rates.