An accurate predictor of liver failure and death after hepatectomy: A single institution’s experience with 478 consecutive cases

Table 1 Liver disease etiologies among the enrolled patients (n = 478)

Etiology	n (%)
Malignant disease	371 (77.6)
HCC	323 (67.6)
Colorectal metastasis	25 (5.2)
Other metastatic disease	12 (2.5)
Cholangiocarcinoma	9 (1.9)
Gallbladder carcinoma	2 (0.4)
Benign disease	107 (22.4)
HCH	72 (15.1)
FNH	13 (2.7)
Hepatic echinococcosis	7 (1.5)
Hepatic complex cysts	2 (0.4)
Adenoma	9 (1.9)
Cystadenoma	3 (0.6)

HCC: Hepatocellular carcinoma; HCH: Hepatic cavernous hemangioma; FNH: Focal nodular hyperplasia.

Table 2 Postoperative complications in the entire patient cohort (n = 478)

Complication	n (%)
Cardiopulmonary	90 (18.8)
Myocardial infarction	4 (0.8)
Cardiac arrest	15 (3.1)
Congestive heart failure	6 (1.3)
Respiratory insufficiency/failure1	12 (2.5)
Pneumonia	34 (7.1)
Pleural effusion (symptomatic)	19 (4.0)
Liver/biliary	70 (14.6)
Increased bilirubin2	59 (12.3)
Bile leak/biloma	5 (1.0)
Cholangitis	6 (1.3)
Gastrointestinal	12 (2.5)
Ileus	5 (1.0)
Gastrointestinal hemorrhage	7 (1.5)
Infection	34 (7.1)
Deep wound infection	23 (4.8)
Sepsis/bacteremia	11 (2.3)
Renal and genitourinary	59 (12.3)
Renal insufficiency/failure	17 (3.6)
Urinary tract infection	23 (4.8)
Urinary retention	19 (4.0)
Miscellaneous	23 (4.8)
Deep venous thrombosis	5 (1.0)
Need for reoperation	7 (1.5)
Perioperative hemorrhage	11 (2.3)
Others3	10 (2.1)

¹Prolonged ventilatory requirement or reintubation, hypoxia with prolonged supplemental oxygen requirement;

²Not included in calculation of composite endpoint as a major postoperative complication;

³Stroke/TIA (n = 1), pericarditis/pericardial effusion (n = 2), perihepatic abscess (n = 2), portal vein thrombosis (n = 1), biliary stricture (n = 3), perforated duodenal ulcer (n = 1).

Table 3 Diagnostic characteristics of total bilirubin, international normalized ratio and combined criteria on postoperative day (3, 5, 7) in the prediction of liver failure-related death

Criteria	AUC	95%CI	Sensitivity	Specificity	P value	Cut-off value
POD 3
TBIL-r1	0.686	0.642-0.727	92.90%	51.70%	0.018	1.24
INR-r1	0.658	0.614-0.701	64.30%	64.90%	0.046	0.94
Combination1	0.719	0.676-0.759	64.30%	74.80%	0.005	0.0337
POD 5
TBIL-r1	0.918	0.890-0.941	85.70%	87.50%	1.0e-7	1.68
INR-r1	0.719	0.677-0.759	50.00%	94.80%	0.006	1.02
Combination1	0.951	0.927-0.968	92.90%	90.10%	9.0e-9	0.0379
TBIL	0.810	0.772-0.844	78.60%	81.50%	7.7e-5	51.0
INR	0.708	0.665-0.748	85.70%	64.40%	0.008	1.23
Combination2	0.829	0.792-0.861	99.80%	57.50%	2.8e-5	0.0164
POD 7
TBIL-r1	0.937	0.912-0.957	85.70%	91.60%	2.4e-8	1.61
INR-r1	0.796	0.757-0.831	71.40%	80.00%	1.5e-4	0.91
Combination1	0.975	0.956-0.987	92.90%	94.40%	1.4e-9	0.0566
TBIL	0.886	0.854-0.913	92.90%	79.10%	1.0e-6	49.5
INR	0.798	0.760-0.833	85.70%	73.30%	1.4e-4	1.22
Combination2	0.908	0.879-0.933	92.90%	79.70%	8.7e-7	0.0277

¹The combination of TBIL-r1 and INR-r1 used the predicted probabilities, which were calculated using logistic regression analysis;

²The combination of TBIL and INR used the predicted probabilities, which were calculated using logistic regression analysis. AUC: Area under the receiver operating curve; TBIL: Total bilirubin; INR: International normalized ratio; TBIL-r1: The ratio of total bilirubin on postoperative day (POD) X to the value on POD 1; INR-r1: The ratio of international normalized ratio on POD X to the value on POD 1.

Table 4 Univariate analysis of factors associated with the hepatic damage score (n = 478)

Variable	Group 1 (n = 380)	Group 2 (n = 98)	t	χ2	P value
Age (yr)	47.5 ± 12.4	46.2 ± 11.4	0.946		0.345
Gender				0.639	0.424
Male	306	83
Female	72	15
TBIL (µmol/L)1	17.5 ± 6.2	18.6 ± 5.7	-1.516		0.130
ALB (g/L)1	40.0 ± 5.0	39.6 ± 5.0	0.737		0.462
ALT (IU/L)1	55 ± 47	54 ± 30	0.117		0.907
AST (IU/L)1	60 ± 54	64 ± 41	-0.557		0.578
CREA (µmol/L)1	0.92 ± 0.28	0.94 ± 0.27	-0.692		0.489
ICG R15 (%)1	7.2 ± 4.3	8.7 ± 5.5	-2.598		0.010
INR1	1.09 ± 0.10	1.07 ± 0.11	1.305		0.192
HBsAg1				0.201	0.654
Positive	268	72
Negative	112	26
CTP grade1				7.735	0.007
A	351	81
B	29	17
MELD score1	5.8 ± 3.8	6.2 ± 3.4	-0.981		0.327
IBL (mL)	731 ± 790	972 ± 953	-2.309		0.022
IBT (mL)	427 ± 764	649 ± 943	-2.157		0.033
RS	2.4 ± 1.0	3.8 ± 1.4	-9.852		2. 0e-17

¹All parameters were measured one day before liver resection. BIL: Total bilirubin; ALB: Albumin; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; CREA: Creatinine; ICG-R15: The indocyanine green retention rate at 15 min; INR: International normalized ratio; HBsAg: Hepatitis B surface antigen; CTP: Child-Turcotte-Pugh; MELD: Model for end-stage liver disease; IBL: Intraoperative blood loss; IBT: Intraoperative blood transfusion; RS: Resected segments.

Table 5 Multivariate analysis of the hepatic damage score

Variable	β	SE	Wald	P value	Exp (β)	95%CI
						Lower	Upper
ICG-R15	0.176	0.03	35.080	3.2e-9	1.192	1.125	1.263
RS	1.292	0.142	83.158	7.6e-20	3.639	2.757	4.803

ICG-R15: The indocyanine green retention rate at 15 min; RS: Resected segments.