Dept of HPB Surgery, Queen Elizabeth Hospital, Birmingham B15 2WB, United Kingdom.
Institute of Translational Medicine, Queen Elizabeth Hospital Birmingham, Birmingham B15 2TH, United Kingdom.
HPB (Oxford). 2019 May;21(5):539-546. doi: 10.1016/j.hpb.2018.09.011. Epub 2018 Oct 22.
Post hepatectomy liver failure (PHLF) is a serious complication in patients undergoing liver resection. This study hypothesized that a new pre-operative risk score developed through statistical modeling to predict PHLF could be used to stratify patients at higher risk of PHLF.
Patients who underwent hepatectomy between 2008 and 2016 were included in the derivation and validation cohorts. A multivariable binary logistic regression model was performed to identify predictors of PHLF, and a prognostic score was derived.
A total of 1269 patients were included in the derivation cohort. PHLF was encountered in 13.1% and was associated with significantly increased 90-day mortality and prolonged post-operative hospital stay (both p < 0.001). Multivariable analysis identified the extent of surgery (p < 0.001) and pre-operative bilirubin (p = 0.015), INR (p < 0.001), and creatinine (p = 0.048) to be independent predictors of PHLF. A risk score derived from these factors returned an area under the ROC curve (AUROC) of 0.816 (p < 0.001) for an internal validation cohort (N = 453), significantly outperforming the MELD score (AUROC: 0.643).
The PHLF risk score could be used to stratify the risk of PHLF among patients planned for hepatectomy.
肝切除术后肝功能衰竭（PHLF）是肝切除术患者的严重并发症。本研究假设通过统计建模开发的新术前风险评分可用于分层 PHLF 风险较高的患者。
纳入 2008 年至 2016 年间接受肝切除术的患者，进行多变量二项逻辑回归模型分析以确定 PHLF 的预测因素，并得出预后评分。
共纳入 1269 例患者作为推导队列。13.1%的患者发生 PHLF，与 90 天死亡率显著增加和术后住院时间延长显著相关（均 p<0.001）。多变量分析确定手术范围（p<0.001）和术前胆红素（p=0.015）、INR（p<0.001）和肌酐（p=0.048）是 PHLF 的独立预测因素。从这些因素中得出的风险评分在内部验证队列（N=453）中的 ROC 曲线下面积（AUROC）为 0.816（p<0.001），显著优于 MELD 评分（AUROC：0.643）。
PHLF 风险评分可用于分层计划接受肝切除术的患者的 PHLF 风险。
