Predicting risk of post-hepatectomy liver failure in patients undergoing liver resection with controlled low central venous pressure

doi:10.4240/wjgs.v17.i5.102335

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May 27, 2025 (publication date) through May 23, 2025

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World Journal of Gastrointestinal Surgery

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1948-9366

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Study

World J Gastrointest Surg. May 27, 2025; 17(5): 102335
Published online May 27, 2025. doi: 10.4240/wjgs.v17.i5.102335

Table 1 Baseline characteristics in non-post-hepatectomy liver failure and post-hepatectomy liver failure groups, n (%)

Variable	Total (n = 285)	Non-PHLF (n = 221)	PHLF (n = 64)	P value
Preoperative risk factors
Gender	-	-	-	0.008
Male	141 (49.5)	100 (45.2)	41 (64.1)	-
Female	144 (50.5)	121 (54.8)	23 (35.9)	-
Age (years)	54.0 (48.0-61.0)	54.0 (47.0-61.0)	55.0 (49.0-62.0)	0.264
BMI (kg/m²), mean ± SD	22.5 ± 2.8	22.3 ± 2.8	22.9 ± 3.0	0.197
LOS (d), mean ± SD	18.1 ± 7.5	16.6 ± 5.9	23.2 ± 9.8	< 0.001
History of hepatitis	-	-	-	0.046
No	198 (69.5)	160 (72.4)	38 (59.4)	-
Yes	87 (30.5)	61 (27.6)	26 (40.6)	-
Cirrhosis	-	-	-	< 0.001
No	203 (71.2)	174 (78.7)	29 (45.3)	-
Yes	82 (28.8)	47 (21.3)	35 (54.7)	-
Jaundice	-	-	-	0.001
No	254 (89.1)	204 (92.3)	50 (78.1)	-
Yes	31 (10.9)	17 (7.7)	14 (21.9)
Ascites	-	-	-	0.263
No	252 (89.7)	197 (90.8)	55 (85.9)	-
Yes	29 (10.3)	20 (9.2)	9 (14.1)	-
Child-Pugh score	-	-	-	< 0.001
5	211 (74.0)	174 (78.7)	37 (57.8)	-
6	45 (15.8)	34 (15.4)	11 (17.2)	-
7	21 (7.4)	9 (4.1)	12 (18.8)	-
8	6 (2.1)	3 (1.4)	3 (4.7)	-
9	2 (0.7)	1 (0.5)	1 (1.6)	-
Cause of liver resection	-	-	-	< 0.001
Tumor	122 (42.8)	81 (36.7)	41 (64.1)	-
Other	163(57.2)	140 (63.3)	23(35.9)
TC (mmol/L)	4.4 ± 1.1	4.4 ± 1.0	4.2 ± 1.4	0.299
LDL-C (mmol/L)	2.6 (2.1-3.2)	2.6 (2.1-3.2)	2.4 (2.1-3.0)	0.206
TG (mmol/L)	1.2 (0.8-1.8)	1.2 (0.8-1.8)	1.0 (0.8-1.6)	0.515
Neutrophils (10⁹/L)	3.4 (2.6-4.6)	3.5 (2.6-4.7)	3.2 (2.5- 4.4)	0.332
Lymphocytes (10⁹/L), mean ± SD	1.6 ± 0.6	1.7 ± 0.6	1.4 ± 0.5	0.004
Leukocytes (10⁹/L)	5.7 (4.6-7.1)	5.8 (4.7-7.2)	5.3 (4.3-6.7)	0.059
Platelets (10⁹/L)	200.5 (149.0-264.0)	213.0 (163.0-264.0)	153.0 (108.0-249.5)	< 0.001
Hemoglobin (g/L)	128.4 ± 18.4	128.7 ± 16.4	127.3 ± 24.1	0.596
Albumin (g/L)	40.6 ± 5.1	41.2 ± 4.9	38.4 ± 5.1	< 0.001
TBIL (μmol/L)	14.9 (11.4-20.8)	14.5 (11.0-20.2)	17.0 (12.4-29.7)	0.012
DBIL (μmol/L)	5.0 (3.7-7.7)	4.8 (3.6-7.2)	5.5 (4.2-12.3)	0.005
ALT (U/L)	31.4 (19.0-56.4)	28.8 (18.0-50.7)	46.3 (28.1-66.5)	0.001
AST (U/L)	28.4 (21.8-45.2)	26.2 (20.8-39.2)	38.8 (28.7-52.6)	< 0.001
Intraoperative risk factors
Operation mode	-	-	-	0.611
Laparoscopic	153 (53.7)	122 (55.2)	31 (48.4)	-
Open	119 (41.8)	89 (40.3)	30 (46.9)	-
Conversion from laparoscopic to open	13 (4.6)	10 (4.5)	3 (4.7)	-
Extensive resection	-	-	-	0.09
No	160 (56.1)	130 (58.8)	30 (46.9)	-
Yes	125 (43.9)	91 (41.2)	34 (53.1)	-
Operation time (min)	327.7 ± 154.9	306.2 ± 134.4	401.8 ± 194.4	< 0.001
Liver blockage time (min)	41.0 (22.0-72.0)	38.0 (21.0-63.0)	58.0 (24.0-95.0)	0.003
Number of blocks	3.0 (1.0-4.0)	2.0 (1.0-4.0)	4.0 (2.0-6.0)	0.002
Total amount volume (mL), mean ± SD	2684.2 ± 1155.3	2490.7 ± 901.6	3352.6 ± 1610.2	< 0.001
Blood loss volume (mL)	200.0 (100.0-400.0)	200.0 (100.0-300.0)	300.0 (200.0-800.0)	< 0.001
Infusion of blood products	-	-	-	0.001
No	254 (89.1)	204 (92.3)	50 (78.1)	-
Yes	31 (10.9)	17 (7.7)	14 (21.9)	-
Urine volume (mL)	500.0 (300.0-950.0)	500.0 (300.0-800.0)	700.0 (362.5-1137.5)	0.001
Infusion of albumin	-	-	-	0.523
No	71 (24.9)	57 (25.8)	14 (21.9)	-
Yes	214 (75.1)	164 (74.2)	50 (78.1)	-
Pre-blocking PCO₂ (mmHg)	42.0 (37.0-48.0)	43.0 (37.0-48.0)	42.0 (37.0-49.0)	0.91
Post-blocking PCO₂ (mmHg)	43.0 (36.0-49.0)	43.5 (36.0-48.2)	43.0 (37.0-50.0)	0.535
Pre-blocking potassium (mmol/L)	3.7 (3.4-4.0)	3.6 (3.4-3.9)	3.7 (3.5-4.0)	0.15
Post-blocking potassium (mmol/L)	4.0 ± 0.6	3.9 ± 0.6	4.3 ± 0.6	< 0.001
Pre-blocking glucose (mmol/L)	5.8 (5.2-6.8)	5.8 (5.2-6.7)	6.2 (5.4-7.3)	0.25
Post-blocking glucose (mmol/L)	9.2 (7.0-11.1)	8.9 (7.0-11.0)	9.3 (7.0-11.0)	0.768
Pre-blocking lactic acid (mmol/L)	0.8 (0.6-1.2)	0.8 (0.6-1.2)	1.0 (0.7-1.4)	0.019
Post-blocking lactic acid (mmol/L)	1.6 (1.1-2.3)	1.4 (1.0-2.0)	2.0 (1.3-3.0)	< 0.001

PHLF: Post-hepatectomy liver failure; BMI: Body mass index; LOS: Length of stay; TC: Total cholesterol; LDL-C: Low-density lipoprotein cholesterol; TG: Triglycerides; TBIL: Total bilirubin; DBIL: Direct bilirubin; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase.

Table 2 Univariate and multivariate logistic analyses for preoperative risk factors

Variable	Univariate logistic regression analysis		Multivariate logistic regression analysis
Variable	OR, 95%CI	P value	OR, 95%CI	P value
Preoperative serum albumin level	0.89 (0.84-0.95)	< 0.001	0.93 (0.87-1)	0.036
Lymphocytes (10⁹/L)	0.45 (0.26-0.78)	0.004	0.81 (0.41-1.61)	0.55
PLT (10⁹/L)	0.99 (0.99-1)	0.001	1 (0.99-1)	0.212
Prothrombin time (s)	1.35 (1.09-1.67)	0.006	1.19 (0.8-1.77)	0.389
Prothrombin activity level (%)	0.99 (0.98-1)	0.043	1 (0.98-1.02)	0.822
TBIL (μmol/L)	1.02 (1.01-1.03)	0.001	1 (0.96-1.05)	0.917
DBIL (μmol/L)	1.03 (1.01-1.05)	0.002	1.01 (0.95-1.09)	0.697
Causes of liver resection, (cancer or others)	0.32 (0.18-0.58)	< 0.001	0.39 (0.16-0.94)	0.037
Gender	2.16 (1.21-3.83)	0.009	1.55 (0.75-3.19)	0.238
History of viral hepatitis	1.79 (1.01-3.2)	0.048	0.72 (0.29-1.82)	0.492
Cirrhosis	4.47 (2.48-8.05)	< 0.001	3.1 (1.56-6.17)	0.001
Jaundice	3.36 (1.55-7.27)	0.002	0.98 (0.28-3.42)	0.972

OR: Odds ratio; CI: Confidence interval; PLT: Platelets; TBIL: Total bilirubin; DBIL: Direct bilirubin.

Table 3 Univariate and multivariate logistic analyses for intraoperative risk factors

Variable	Univariate logistic regression analysis		Multivariate logistic regression analysis
Variable	OR, 95%CI	P value	OR, 95%CI	P value
Urinary production (mL)	1.001 (1-1.001)	< 0.001	1 (1-1)	0.593
Blood loss volume (mL)	1.002 (1.001-1.002)	< 0.001	1 (1-1)	0.567
Infusion fluid volume (mL)	1.001 (1-1.001)	< 0.001	1 (1-1)	0.148
Blood transfusion	3.36 (1.553-7.272)	0.002	0.94 (0.25-3.56)	0.93
Operation time (min)	1.004 (1.002-1.006)	< 0.001	1 (1-1)	0.954
Hepatic portal occlusion time (min)	1.014 (1.007-1.021)	< 0.001	1.01 (0.97-1.04)	0.641
Number of blocks	1.255 (1.12-1.406)	< 0.001	0.93 (0.55-1.57)	0.787
Post-blocking blood potassium (mmol/L)	2.222 (1.362-3.627)	0.001	1.82 (1.05-3.17)	0.033
Post-blocking blood lactate (mmol/L)	1.491 (1.164-1.908)	0.002	1.08 (0.8-1.46)	0.629

OR: Odds ratio; CI: Confidence interval.

Table 4 Baseline characteristics in training and validation groups, n (%)

Variable	Total (n = 285)	Training group (n = 199)	Validation group (n = 85)	P value
PHLF (%)	-	-	-	0.504
No	221	157 (78.9)	64 (75.3)	-
Yes	64	42 (21.1)	21 (24.7)	-
Preoperative risk factors
Gender	-	-	-	0.98
Male	141 (49.5)	101 (50.8)	43 (50.6)	-
Female	144 (50.5)	98 (49.2)	42 (49.4)	-
Age (years)	54.0 (48.0-61.0)	54.0 (48.0-61.0)	55.0 (49.0-62.0)	0.262
BMI (kg/m²), mean ± SD	22.5 ± 2.8	22.4 ± 2.8	22.6 ± 2.9	0.551
LOS (d), mean ± SD	18.1 ± 7.5	17.7 ± 7.0	19.0 ± 8.5	0.175
History of hepatitis	-	-	-	0.266
No	198 (69.5)	142 (71.4)	55 (64.7)	-
Yes	87 (30.5)	57 (28.6)	30 (35.3)	-
Cirrhosis	-	-	-	0.52
No	203 (71.2)	140 (70.4)	63 (74.1)	-
Yes	82 (28.8)	59 (29.6)	22 (25.9)	-
Jaundice	-	-	-	0.474
No	254 (89.1)	179 (89.9)	74 (87.1)	-
Yes	31 (10.9)	20 (10.1)	11 (12.9)	-
Ascites	-	-	-	0.572
No	252 (89.7)	180 (90.5)	75 (88.2)	-
Yes	29 (10.3)	19 (9.5)	10 (11.8)	-
Child-Pugh score		-	-	0.198
5	211 (74.0)	144 (72.4)	66 (77.6)	-
6	45 (15.8)	35 (17.6)	10 (11.8)	-
7	21 (7.4)	16 (8)	5 (5.9)	-
8	6 (2.1)	4 (2)	2 (2.4)	-
9	2 (0.7)	0 (0)	2 (2.4)	-
Cause of liver resection	-	-	-	0.041
Tumor	122 (42.8)	77 (38.7)	44 (51.8)	-
Other	163(57.2)	122 (61.3)	41 (48.2)	-
TC (mmol/L), mean ± SD	4.4 ± 1.1	4.3 ± 1.1	4.4 ± 1.1	0.625
LDL-C (mmol/L)	2.6 (2.1-3.2)	2.5 (2.1-3.2)	2.7 (2.1-3.0)	0.816
TG (mmol/L)	1.2 (0.8-1.8)	1.2 (0.8-1.7)	1.1 (0.8-1.9)	0.941
Neutrophils (10⁹/L)	3.4 (2.6-4.6)	3.5 (2.6-4.6)	3.4 (2.6-4.6)	0.698
Lymphocytes (10⁹/L)	1.6 ± 0.6	1.6 ± 0.6	1.6 ± 0.5	0.447
Leukocytes (10⁹/L)	5.7 (4.6-7.1)	5.7 (4.7-7.2)	5.6 (4.5-7.0)	0.738
Platelets (10⁹/L)	200.5 (149.0-264.0)	199.0 (149.0-259.0)	206.0 (156.0-279.0)	0.587
Hemoglobin (g/L)	128.4 ± 18.4	127.8 ± 18.1	129.9 ± 19.1	0.382
Albumin (g/L)	40.6 ± 5.1	40.4 ± 5.2	41.0 ± 4.8	0.394
TBIL (μmol/L)	14.9 (11.4-20.8)	14.8 (10.9-22.4)	15.2 (11.9-19.8)	0.873
DBIL (μmol/L)	5.0 (3.7-7.7)	5.1 (3.7-7.8)	4.8 (4.0-7.6)	0.969
ALT (U/L)	31.4 (19.0-56.4)	31.5 (19.6-59.0)	30.0 (18.5-46.3)	0.230
AST (U/L)	28.4 (21.8-45.2)	28.9 (21.6-46.0)	28.1 (22.0-44.6)	0.905
Intraoperative risk factors
Operation mode	-	-	-	0.378
Laparoscopic	153 (53.7)	107 (53.8)	46 (54.1)	-
Open	119 (41.8)	85 (42.7)	33 (38.8)	-
Conversion from laparoscopic to open	13 (4.6)	7 (3.5)	6 (7.1)	-
Extensive resection	-	-	-	0.416
No	160 (56.1)	109 (54.8)	51 (60)	-
Yes	125 (43.9)	90 (45.2)	34 (40)	-
Operation length (min), mean ± SD	327.7 ± 154.9	322.1 ± 155.8	340.5 ± 153.7	0.360
Liver blockage time (min)	41.0 (22.0-72.0)	40.0 (18.2-68.0)	43.0 (28.0-75.0)	0.294
Number of blocks	3.0 (1.0-4.0)	3.0 (1.0-4.0)	3.0 (2.0-5.0)	0.520
Total amount volume (mL), mean ± SD	2684.2 ± 1155.3	2696.7 ± 1134.0	2647.2 ± 1214.2	0.742
Blood loss volume (mL)	200.0 (100.0-400.0)	200.0 (100.0-400.0)	200.0 (150.0-400.0)	0.102
Infusion of blood products	-	-	-	0.344
No	254 (89.1)	175 (87.9)	78 (91.8)	-
Yes	31 (10.9)	24 (12.1)	7 (8.2)	-
Urine volume (mL)	500.0 (300.0-950.0)	500.0 (300.0-912.5)	500.0 (300.0-1000.0)	0.995
Infusion of albumin	-	-	-	0.752
No	71 (24.9)	48 (24.1)	22 (25.9)	-
Yes	214 (75.1)	151 (75.9)	63 (74.1)	-
Pre-blocking PCO₂ (mmHg)	42.0 (37.0-48.0)	42.0 (37.0-49.0)	42.0 (35.0-47.0)	0.480
Post-blocking PCO₂ (mmHg)	43.0 (36.0-49.0)	43.0 (36.0-49.0)	44.0 (36.0-49.5)	0.805
Pre-blocking potassium (mmol/L)	3.7 (3.4-4.0)	3.6 (3.3-3.9)	3.7 (3.5-4.0)	0.072
Post-blocking potassium (mmol/L), mean ± SD	4.0 ± 0.6	4.0 ± 0.6	4.1 ± 0.7	0.082
Pre-blocking glucose (mmol/L)	5.8 (5.2-6.8)	5.8 (5.2-6.8)	5.8 (5.2*6.8)	0.876
Post-blocking glucose (mmol/L)	9.2 (7.0-11.1)	8.9 (7.0-10.8)	9.5 (7.5*11.4)	0.181
Pre-blocking lactic acid (mmol/L)	0.8 (0.6-1.2)	0.8 (0.6-1.2)	0.8 (0.7-1.2)	0.744
Post-blocking lactic acid (mmol/L)	1.6 (1.1-2.3)	1.5 (1.0-2.2)	1.6 (1.2-2.5)	0.284

Table 5 Variable filtering

Number	Variable, name	Coefficient	Lambda, type	Lambda, P value
0	Intercept	-0.63	Lambda1se	0.049
1	Gender	-	Lambda1se	0.049
2	History of viral hepatitis	-	Lambda1se	0.049
3	Cirrhosis	0.768	Lambda1se	0.049
4	Jaundice	-	Lambda1se	0.049
5	Causes of liver resection (cancer or others)	-0.37	Lambda1se	0.049
6	Lymphocyte count (10⁹/L)	-	Lambda1se	0.049
7	PLT (10⁹/L)	0	Lambda1se	0.049
8	Preoperative serum albumin level	-0.028	Lambda1se	0.049
9	TBIL (μmol/L)	-	Lambda1se	0.049
10	DBIL (μmol/L)	0.01	Lambda1se	0.049
11	Prothrombin time (second)	-	Lambda1se	0.049
12	Prothrombin activity level (%)	-	Lambda1se	0.049

PLT: Platelets; BIL: Total bilirubin; DBIL: Direct bilirubin.

Citation: Tang L, Chen LX, Luo CC, Zhao Y. Predicting risk of post-hepatectomy liver failure in patients undergoing liver resection with controlled low central venous pressure. World J Gastrointest Surg 2025; 17(5): 102335
URL: https://www.wjgnet.com/1948-9366/full/v17/i5/102335.htm
DOI: https://dx.doi.org/10.4240/wjgs.v17.i5.102335