Olthof Pim B, Huiskens Joost, Schulte Niek R, Wicherts Dennis A, Besselink Marc G, Busch Olivier R, Heger Michal, van Gulik Thomas M
Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Department of Medical Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
HPB (Oxford). 2016 Nov;18(11):915-921. doi: 10.1016/j.hpb.2016.07.016. Epub 2016 Sep 2.
Transaminase levels are usually measured as markers of hepatocellular injury following liver resection, but recent evidence was unclear on their clinical value. This study aimed to identify factors that determine peak postoperative transaminase levels and correlated transaminase levels to postoperative complications.
All liver resections performed at a single center between 2006 and 2015 were included in the analysis. Multivariate analysis was used to identify factors that determine peak ALT and AST levels and postoperative morbidity and mortality. An ALT and AST cutoff for the prediction of mortality was determined using receiver operating characteristic curves analysis.
A total of 539 resections were included. Clavien-Dindo grade III or higher complications, intraoperative transfusion, and operative duration were identified as determinants of peak transaminases. A peak AST cut-off value for predicting mortality was defined at 828 U/L, with an area under the curve of 0.81 (0.73-0.89). The cut-off was an independent predictor of mortality (P < 0.01) along with (intraoperative) transfusion (P < 0.01), fifty-fifty criteria (P < 0.01), and age (P < 0.01).
Postoperative transaminase levels are independent predictors of postoperative morbidity and mortality and therefore clinically relevant. Transaminase levels usually peak during the first 24 h after surgery and thus possess early prognostic power in terms of postoperative mortality.
转氨酶水平通常作为肝切除术后肝细胞损伤的标志物进行检测，但近期证据对其临床价值尚不清楚。本研究旨在确定决定术后转氨酶峰值水平的因素，并将转氨酶水平与术后并发症相关联。
纳入2006年至2015年在单一中心进行的所有肝切除术。采用多变量分析确定决定谷丙转氨酶（ALT）和谷草转氨酶（AST）峰值水平以及术后发病率和死亡率的因素。使用受试者工作特征曲线分析确定预测死亡率的ALT和AST临界值。
共纳入539例肝切除术。Clavien-Dindo III级或更高等级的并发症、术中输血和手术时长被确定为转氨酶峰值的决定因素。预测死亡率的AST峰值临界值定义为828 U/L，曲线下面积为0.81（0.73 - 0.89）。该临界值与（术中）输血（P < 0.01）、五五标准（P < 0.01）和年龄（P < 0.01）一样，是死亡率的独立预测因素（P < 0.01）。
术后转氨酶水平是术后发病率和死亡率的独立预测因素，因此具有临床相关性。转氨酶水平通常在术后24小时内达到峰值，因此在术后死亡率方面具有早期预后价值。
