[Clinical and biological significance of arterial blood ketone body ratio in hepatic surgery].

In a recent study from our laboratory, 372 patients were classified into 4 groups according to the postoperative changes in the arterial blood ketone body ratio: Group A without decrease below 0.7 (greater than 0.7 in control), Group B with transient decrease to 0.4, Group C with progressive decrease to below 0.4, and Group D, the terminal stage, with decrease to below 0.25. Groups A and B patients tolerated operation well. In the 28 Group C patients, 24 of them died of multiple organ failure. The metabolic liver support designed by us (an ex vivo pig or baboon liver cross-hemodialysis with an interposed cuprophan membrane) has been applied for the patients with both blood ketone body ratio below 0.4 and grade IV hepatic coma. All Group C patients became fully alert after liver support concomitant with the restoration of the blood ketone body ratio. By contrast, in Group D patients, there was no restoration of consciousness and no improvement in their blood ketone body ratios by this liver support. It has been suggested that blood ketone body ratio level serves as an excellent indicator of the deranged metabolic process and mortality in critically ill patients.