Early derangement of INR predicts liver failure after liver resection for hepatocellular carcinoma.

Autor: Silva ANS; Department of Surgery, Cambridge University Hospitals, Addenbrookes, Cambridge, United Kingdom; CRUK Cambridge Institute, University of Cambridge, Cambridge, United Kingdom. Electronic address: a.n.s.silva@doctors.org.uk., Greensmith M; Department of Surgery, Cambridge University Hospitals, Addenbrookes, Cambridge, United Kingdom., Praseedom RK; Department of Surgery, Cambridge University Hospitals, Addenbrookes, Cambridge, United Kingdom., Jah A; Department of Surgery, Cambridge University Hospitals, Addenbrookes, Cambridge, United Kingdom., Huguet EL; Department of Surgery, Cambridge University Hospitals, Addenbrookes, Cambridge, United Kingdom., Harper SJF; Department of Surgery, Cambridge University Hospitals, Addenbrookes, Cambridge, United Kingdom., Liau SS; Department of Surgery, Cambridge University Hospitals, Addenbrookes, Cambridge, United Kingdom., Basu B; CRUK Cambridge Institute, University of Cambridge, Cambridge, United Kingdom., Alexander GJ; UCL Institute for Liver and Digestive Health, Royal Free Hospital Pond St, Hampstead, London, NW3 2QG, United Kingdom., Brais R; Department of Pathology, Cambridge University Hospitals, Addenbrookes, Cambridge, United Kingdom., See TC; Department of Radiology, Cambridge University Hospitals, Addenbrookes, Cambridge, United Kingdom., Hoare M; CRUK Cambridge Institute, University of Cambridge, Cambridge, United Kingdom; Department of Hepatology, University of Cambridge, Cambridge, United Kingdom., Gibbs P; Department of Surgery, Cambridge University Hospitals, Addenbrookes, Cambridge, United Kingdom., Balakrishnan A; Department of Surgery, Cambridge University Hospitals, Addenbrookes, Cambridge, United Kingdom. Electronic address: anita.balakrishnan@addenbrookes.nhs.uk.
Jazyk: angličtina
Zdroj: The surgeon : journal of the Royal Colleges of Surgeons of Edinburgh and Ireland [Surgeon] 2022 Oct; Vol. 20 (5), pp. e288-e295. Date of Electronic Publication: 2022 Feb 07.
DOI: 10.1016/j.surge.2022.01.002
Abstrakt: Background: Surgical resection, where appropriate, remains one of the best treatment options for hepatocellular carcinoma (HCC), however outcomes can be compromised by the development of liver failure. We reviewed our experience of liver resection for HCC patients to identify factors that may predict the development of post-hepatectomy liver failure (PHLF) and survival.
Methods: A single centre retrospective cohort study. Data was collected between 1999 and 2017 from all patients undergoing HCC resection in a tertiary university hospital from electronic medical records. PHLF was defined as per the International Study Group for Liver Surgery criteria. Variables with p < 0.15 on univariate analysis were included in a multivariate binary logistic regression model. Kaplan-Meier analyses were used to determine correlations with overall survival (OS) and disease-free survival (DFS), and variables with p < 0.15 on univariate analysis selected for a step-down Cox proportional hazard regression model.
Results: Overall, 120 patients underwent liver resection within the study period, of which 22 (18%) developed PHLF. Patients with normal INR ≤1.20 at day 2 did not develop PHLF whereas patients with INR >1.60 were at significant risk. Resection of multiple tumours (odds ratio 21.63, p = 0.002) and deranged postoperative day 2 INR>1.6 (odds ratio 21.05, p < 0.0001) were identified as independent prognostic markers of PHLF.
Conclusion: The use of INR measurement at day 2 predicts PHLF and may enable us to objectively identify and stratify patients who may be eligible for enhanced recovery programs from those who will merit close monitoring in high dependency areas.
Competing Interests: Declaration of competing interest Silva ANS reports no conflict of interest. Greensmith M reports no conflict of interest. Praseedom RK reports no conflict of interest. Jah A reports no conflict of interest. Huguet EL reports no conflict of interest. Harper SJF reports no conflict of interest. Liau SS reports no conflict of interest. Basu B reports no conflict of interest. Alexander GJ reports no conflict of interest. Brais R reports no conflict of interest. See TC reports no conflict of interest. Hoare M reports no conflict of interest. Gibbs P reports no conflict of interest. Balakrishnan A reports no conflict of interest.
(Crown Copyright © 2022. Published by Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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