Lee Gil Ho, Cho Hyo Jung, Lee Garam, Kim Han Gyeol, Wang Hee Jung, Kim Bong-Wan, Lee Mi Young, Yoon So Young, Noh Choong-Kyun, Seo Chul Won, Eun Jung Woo, Cheong Jae Youn, Cho Sung Won, Kim Soon Sun
Department of Gastroenterology, Ajou University School of Medicine, Suwon, Republic of Korea.
Department of Surgery, Ajou University School of Medicine, Suwon, Republic of Korea.
Ann Transl Med. 2021 Feb;9(3):190. doi: 10.21037/atm-20-5194.
Bioelectrical impedance analysis provides information on body composition and nutritional status. However, it's unclear whether the preoperative edema index or phase angle predicts postoperative complication or mortality in patients with hepatocellular carcinoma (HCC). Thus, we investigated whether preoperative bioelectrical impedance analysis could predict postoperative complications and survival in patients with HCC.
Seventy-nine patients who underwent hepatectomy for hepatocellular carcinoma were prospectively enrolled and bioelectrical impedance analysis was performed before surgery. Postoperative ascites or acute kidney injury and patients' survival were monitored after surgery.
Among 79 patients, 35 (44.3%) developed ascites or acute kidney injury after hepatectomy. In multivariate analysis, a high preoperative edema index (extracellular water/total body water) (>0.384) (odds ratio 3.96; 95% confidence interval: 1.03-15.17; P=0.045) and higher fluid infusion during surgery (odds ratio 1.36; 95% confidence interval: 1.04-1.79; P=0.026) were identified as significant risk factors for ascites or acute kidney injury after hepatectomy. Subgroup analyses showed that the edema index was a significant predictor of ascites or acute kidney injury in patients with cirrhosis. Tumor size was the only significant predictive factor for short-term survival after hepatectomy.
The preoperative edema index using bioelectrical impedance analysis can be used as a predictor of post-hepatectomy complication, especially in patients with liver cirrhosis.
生物电阻抗分析可提供身体成分和营养状况的信息。然而，术前水肿指数或相位角能否预测肝细胞癌（HCC）患者术后并发症或死亡率尚不清楚。因此，我们研究了术前生物电阻抗分析能否预测HCC患者术后并发症及生存情况。
前瞻性纳入79例行肝细胞癌肝切除术的患者，并在术前进行生物电阻抗分析。术后监测患者腹水或急性肾损伤情况及生存情况。
79例患者中，35例（44.3%）肝切除术后出现腹水或急性肾损伤。多因素分析显示，术前高水肿指数（细胞外液/总体液）（>0.384）（比值比3.96；95%置信区间：1.03 - 15.17；P = 0.045）和术中较高的液体输注量（比值比1.36；95%置信区间：1.04 - 1.79；P = 0.026）被确定为肝切除术后腹水或急性肾损伤的显著危险因素。亚组分析表明，水肿指数是肝硬化患者腹水或急性肾损伤的显著预测指标。肿瘤大小是肝切除术后短期生存的唯一显著预测因素。
使用生物电阻抗分析得出的术前水肿指数可作为肝切除术后并发症的预测指标，尤其是在肝硬化患者中。
