Using the Comprehensive Complication Index to Rethink the ISGLS Criteria for Post-hepatectomy Liver Failure in an International Cohort of Major Hepatectomies.
Journal
Annals of surgery
ISSN: 1528-1140
Titre abrégé: Ann Surg
Pays: United States
ID NLM: 0372354
Informations de publication
Date de publication:
01 03 2023
01 03 2023
Historique:
pmc-release:
01
03
2024
pubmed:
17
12
2021
medline:
9
2
2023
entrez:
16
12
2021
Statut:
ppublish
Résumé
To compare different criteria for post-hepatectomy liver failure (PHLF) and evaluate the association between International Study Group of Liver Surgery (ISGLS) PHLF and the Comprehensive Complication Index (CCI)" and 90-day mortality. PHLF is a serious complication following hepatic resection. Multiple criteria have been developed to characterize PHLF. Adults who underwent major hepatectomies at twelve international centers (2010-2020) were included. We identified patients who met criteria for PHLF based on three definitions: 1) ISGLS, 2) Balzan (INR > 1.7 and bilirubin > 2.92mg/dL) or 3) Mullen (peak bilirubin >7mg/dL). We compared the 90-day mortality and major morbidity predicted by each definition. We then used logistic regression to determine the odds of CCI>40 and 90-day mortality associated with ISGLS grades. Among 1646 included patients, 19 (1.1%) met Balzan, 68 (4.1%) met Mullen, and 444 (27.0%) met ISGLS criteria for PHLF. Of the three definitions, the ISGLS criteria best predicted 90-day mortality (AUC = 0.72; sensitivity 69.4%). Patients with ISGLS grades B&C were at increased odds of CCI > 40 (grade B OR 4.0; 95% CI: 2.2-7.2; grade C OR 137.0; 95% CI: 59.2-317.4). Patients with ISGLS grade C were at increased odds of 90-day mortality (OR 113.6; 95% CI: 55.6-232.1). Grade A was not associated with CCI> 40 or 90-day mortality. In this diverse international cohort of major hepatectomies, ISGLS grade A was not associated with 90-day mortality or high CCI, calling into question the current classification of patients in this group as having clinically significant PHLF.
Sections du résumé
OBJECTIVE
To compare different criteria for post-hepatectomy liver failure (PHLF) and evaluate the association between International Study Group of Liver Surgery (ISGLS) PHLF and the Comprehensive Complication Index (CCI)" and 90-day mortality.
SUMMARY OF BACKGROUND DATA
PHLF is a serious complication following hepatic resection. Multiple criteria have been developed to characterize PHLF.
METHODS
Adults who underwent major hepatectomies at twelve international centers (2010-2020) were included. We identified patients who met criteria for PHLF based on three definitions: 1) ISGLS, 2) Balzan (INR > 1.7 and bilirubin > 2.92mg/dL) or 3) Mullen (peak bilirubin >7mg/dL). We compared the 90-day mortality and major morbidity predicted by each definition. We then used logistic regression to determine the odds of CCI>40 and 90-day mortality associated with ISGLS grades.
RESULTS
Among 1646 included patients, 19 (1.1%) met Balzan, 68 (4.1%) met Mullen, and 444 (27.0%) met ISGLS criteria for PHLF. Of the three definitions, the ISGLS criteria best predicted 90-day mortality (AUC = 0.72; sensitivity 69.4%). Patients with ISGLS grades B&C were at increased odds of CCI > 40 (grade B OR 4.0; 95% CI: 2.2-7.2; grade C OR 137.0; 95% CI: 59.2-317.4). Patients with ISGLS grade C were at increased odds of 90-day mortality (OR 113.6; 95% CI: 55.6-232.1). Grade A was not associated with CCI> 40 or 90-day mortality.
CONCLUSIONS
In this diverse international cohort of major hepatectomies, ISGLS grade A was not associated with 90-day mortality or high CCI, calling into question the current classification of patients in this group as having clinically significant PHLF.
Identifiants
pubmed: 34913896
doi: 10.1097/SLA.0000000000005338
pii: 00000658-202303000-00042
pmc: PMC9308484
mid: NIHMS1824194
doi:
Substances chimiques
Bilirubin
RFM9X3LJ49
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e592-e596Subventions
Organisme : NIAID NIH HHS
ID : T32 AI125222
Pays : United States
Organisme : NCI NIH HHS
ID : T32 CA251070
Pays : United States
Organisme : NCATS NIH HHS
ID : TL1 TR001871
Pays : United States
Investigateurs
Yuta Abe
(Y)
Thomas Armstrong
(T)
Alessandro Ferrero
(A)
Carlos Corvera
(C)
Koki Hayashi
(K)
Taisuke Imamura
(T)
Minoru Kitago
(M)
Shoji Kubo
(S)
Masatsugu Ishii
(M)
Federico Mocchegiani
(F)
Zenichi Morise
(Z)
Kosuke Ogawa
(K)
Yukiyasu Okamura
(Y)
Shimpei Otsuka
(S)
John Primrose
(J)
Edoardo Rosso
(E)
Fernando Rotellar
(F)
Nadia Russolillo
(N)
Shareef M Syed
(SM)
Minoru Tanabe
(M)
Shogo Tanaka
(S)
Fumihiro Terasaki
(F)
Marco Vivarelli
(M)
Giuseppe Zimmitti
(G)
Informations de copyright
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
The authors report no conflicts of interest.
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