Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL, USA.
Department of Surgery, Emory University, Atlanta, GA, USA.
Ann Surg Oncol. 2020 Aug;27(8):2868-2876. doi: 10.1245/s10434-020-08239-6. Epub 2020 Feb 26.
Post hepatectomy liver failure (PHLF) is associated with significant perioperative morbidity and mortality. A tool to identify patients at risk for PHLF may allow for earlier intervention to mitigate its severity and help clinicians when counseling patients. Our objective was to develop a PHLF risk calculator.
Patients who underwent hepatectomy for any indication from 2014 to 2017 were identified from ACS NSQIP. A multivariable logistic regression model was developed that included preoperative and intraoperative variables. Model fit was assessed for discrimination using the C-statistic, and calibration using Hosmer and Lemeshow (HL) Chi square. Validation of the calculator was performed utilizing tenfold cross validation.
Among 15,636 hepatectomy patients analyzed, the overall incidence of clinically significant PHLF was 2.8%. Preoperative patient factors associated with increased PHLF were male gender, preoperative ascites within 30 days of surgery, higher ASA class, preoperative total bilirubin greater than 1.2 mg/dl, and AST greater than 40 units/l. Disease related factors associated with PHLF included histology, and use of neoadjuvant therapy. Intraoperative factors associated with PHLF were extent of resection, open surgical approach, abnormal liver texture, and biliary reconstruction. The calculator's C-statistic was 0.83 and the HL Chi square was 10.9 (p = 0.21) demonstrating excellent discrimination and calibration. On tenfold cross validation, the mean test group C-statistic was 0.82 and the HL p value was 0.26.
We present a multi-institutional preoperative and early postoperative PHLF risk calculator, which demonstrated excellent discrimination and calibration. This tool can be used to help identify high-risk patients to facilitate earlier interventions.
肝切除术后肝功能衰竭（PHLF）与围手术期高发病率和高死亡率密切相关。一种能够识别 PHLF 风险患者的工具，可能有助于更早地进行干预以减轻其严重程度，并为临床医生提供患者咨询服务。我们的目的是开发一种 PHLF 风险计算器。
从 ACS NSQIP 中确定了 2014 年至 2017 年间因任何原因接受肝切除术的患者。建立了一个多变量逻辑回归模型，其中包括术前和术中变量。使用 C 统计量评估模型的区分度，使用 Hosmer 和 Lemeshow（HL）卡方检验评估校准度。使用十重交叉验证对计算器进行验证。
在分析的 15636 例肝切除术患者中，临床上显著的 PHLF 总发生率为 2.8%。与 PHLF 增加相关的术前患者因素包括男性、手术前 30 天内的腹水、较高的 ASA 分级、术前总胆红素大于 1.2mg/dl 和 AST 大于 40 单位/l。与 PHLF 相关的疾病因素包括组织学和新辅助治疗的使用。与 PHLF 相关的术中因素包括切除范围、开放性手术方法、异常肝质地和胆道重建。该计算器的 C 统计量为 0.83，HL 卡方为 10.9（p=0.21），表明具有良好的区分度和校准度。在十重交叉验证中，实验组的平均 C 统计量为 0.82，HL p 值为 0.26。
我们提出了一种多机构的术前和术后早期 PHLF 风险计算器，该计算器具有良好的区分度和校准度。该工具可用于帮助识别高危患者，以便更早地进行干预。
