Department of Medicine, Virginia Commonwealth University, Richmond, VA, USA.
Division of Gastroenterology and Hepatology, Indiana University School of Medicine, 550 N. University Blvd, UH 4100, Indianapolis, IN, 46202, USA.
Abdom Radiol (NY). 2019 Oct;44(10):3263-3272. doi: 10.1007/s00261-019-02145-6.
The measurement of liver volume (LV) is considered to be an effective prognosticator for postoperative liver failure in patients undergoing hepatectomy. It is unclear whether LV can be used to predict mortality in cirrhotic patients.
We enrolled 584 consecutive cirrhotic patients who underwent computerized topography (CT) of the abdomen for hepatocellular carcinoma surveillance and 50 age, gender, race, and BMI-matched controls without liver disease. Total LV (TLV), functional LV (FLV), and segmental liver volume (in cm) were measured from CT imaging. Cirrhotic subjects were followed until death, liver transplantation, or study closure date of July 31, 2016. The survival data were assessed with log-rank statistics and independent predictors of survival were performed using Cox hazards model.
Cirrhotic subjects had significantly lower TLV, FLV, and segmental (all except for segments 1, 6, 7) volume when compared to controls. Subjects presenting with hepatic encephalopathy had significantly lower TLV and FLV than those without HE (p = 0.002). During the median follow-up of 1145 days, 112 (19%) subjects were transplanted and 131 (23%) died. TLV and FLV for those who survived were significantly higher than those who were transplanted or dead (TLV:1740 vs. 1529 vs. 1486, FLV 1691 vs. 1487 vs. 1444, p < 0.0001). In the Cox regression model, age, MELD score, TLV, or FLV were independent predictors of mortality.
Baseline liver volume is an independent predictor of mortality in subjects with cirrhosis. Therefore, it may be useful to provide these data while performing routine surveillance CT scan as an important added value. Further studies are needed to validate these findings and to better understand their clinical utility.
肝体积（LV）的测量被认为是预测肝切除术后肝功能衰竭的有效指标。目前尚不清楚 LV 是否可用于预测肝硬化患者的死亡率。
我们纳入了 584 例连续接受腹部计算机断层扫描（CT）进行肝细胞癌监测的肝硬化患者，以及 50 例年龄、性别、种族和 BMI 相匹配的无肝病对照者。从 CT 成像中测量总 LV（TLV）、功能性 LV（FLV）和节段性肝体积（cm）。肝硬化患者随访至死亡、肝移植或研究截止日期 2016 年 7 月 31 日。使用对数秩检验评估生存数据，并使用 Cox 风险模型分析生存的独立预测因素。
与对照组相比，肝硬化患者的 TLV、FLV 和节段性体积（除 1、6、7 段外）明显较低。有肝性脑病的患者的 TLV 和 FLV 明显低于无肝性脑病的患者（p=0.002）。在中位随访 1145 天期间，112 例（19%）患者接受了移植，131 例（23%）死亡。存活者的 TLV 和 FLV 明显高于移植或死亡者（TLV：1740 比 1529 比 1486，FLV 1691 比 1487 比 1444，p<0.0001）。在 Cox 回归模型中，年龄、MELD 评分、TLV 或 FLV 是死亡率的独立预测因素。
基线肝体积是肝硬化患者死亡的独立预测因素。因此，在进行常规监测 CT 扫描时提供这些数据可能具有重要的附加价值。需要进一步的研究来验证这些发现，并更好地理解其临床应用。
