Badawy Amr, Seo Satoru, Toda Rei, Fuji Hiroaki, Fukumitsu Ken, Taura Kojiro, Kaido Toshimi, Uemoto Shinji
Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
General Surgery Department, Alexandria University, Alexandria, Egypt.
ANZ J Surg. 2019 Oct;89(10):1275-1280. doi: 10.1111/ans.15368. Epub 2019 Aug 6.
Prediction of early mortality after hepatectomies for hepatocellular carcinoma is essential to identify high-risk patients and to decrease the operative mortality rate. Several post-operative clinical risk scores were developed recently to predict mortality post-hepatectomy; however, which one is the best remains undefined. Therefore, the aim of this study was to evaluate the performance of the different post-operative clinical risk scores in predicting early mortality after hepatectomies.
A total of 240 patients who underwent liver resection for hepatocellular carcinoma at our hospital between June 2011 and July 2016 were retrospectively reviewed. Post-operative clinical risk scores including 50-50 criteria, peak bilirubin >7 mg/dL, model for end-stage liver disease (MELD), risk assessment for early mortality and Hyder scores were evaluated for their performance in predicting early mortality after hepatic resection using the receiver operating characteristic (ROC) curve.
The 90-day mortality rate after hepatic resection was around 2.5%. The 50-50 criteria and peak bilirubin >7 mg/dL were weak predictors of early mortality with low sensitivity (area under the ROC curve: 0.65, 0.66, respectively), whereas, Hyder, risk assessment for early mortality, and post-operative MELD were good predictors of early mortality (area under the ROC curve: 0.89, 0.91 and 0.88, respectively). Moreover, MELD score on post-operative day 3 was an independent risk factor for 90-day mortality with an odds ratio of 1.4 (95% confidence interval 1.06-1.81, P = 0.02).
Post-operative clinical risk scores, especially MELD, were capable of predicting early mortality after liver resection and should be used to identify high-risk patients and provide them with more intensive medical care.
预测肝细胞癌肝切除术后的早期死亡率对于识别高危患者和降低手术死亡率至关重要。最近开发了几种术后临床风险评分来预测肝切除术后的死亡率；然而，哪种评分最佳仍不明确。因此，本研究的目的是评估不同术后临床风险评分在预测肝切除术后早期死亡率方面的性能。
回顾性分析了2011年6月至2016年7月在我院接受肝细胞癌肝切除术的240例患者。使用受试者工作特征（ROC）曲线评估包括50-50标准、胆红素峰值>7mg/dL、终末期肝病模型（MELD）、早期死亡率风险评估和海德评分在内的术后临床风险评分在预测肝切除术后早期死亡率方面的性能。
肝切除术后90天死亡率约为2.5%。50-50标准和胆红素峰值>7mg/dL是早期死亡率的弱预测指标，敏感性较低（ROC曲线下面积分别为0.65、0.66），而海德评分、早期死亡率风险评估和术后MELD是早期死亡率的良好预测指标（ROC曲线下面积分别为0.89、0.91和0.88）。此外，术后第3天的MELD评分是90天死亡率的独立危险因素，比值比为1.4（95%置信区间1.06-1.81，P=0.02）。
术后临床风险评分，尤其是MELD，能够预测肝切除术后的早期死亡率，应用于识别高危患者并为其提供更强化的医疗护理。
