Prospective Validation of the “Fifty-Fifty” Criteria as an Early and Accurate Predictor of Death After Liver Resection in Intensive Care Unit Patients
- 1 January 2009
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Annals of Surgery
- Vol. 249 (1), 124-128
- https://doi.org/10.1097/sla.0b013e31819279cd
Abstract
Postoperative liver failure after hepatectomy has been identified by the association of prothrombin time 50 micromol/L (the "50-50" criteria). Whether these criteria are of prognostic value in a prospective study remains unknown. To determine prospectively the prognostic value of the 50-50 criteria on day 3 and day 5 in intensive care unit (ICU) patients after hepatectomy. From January 2005 to February 2007, among 436 elective liver resections, 99 (23%) consecutive patients aged 58 +/- 17 years were admitted postoperatively in ICU with a mean SAPSII 25 +/- 10. Malignant disease was present in 87 and major resections (< or =3 segments) were performed in 79 (80%) cases. The underlying liver parenchyma was abnormal in 59 (59%) cases including cirrhosis, fibrosis, or steatosis >30% in 19, 23, and 17 patients, respectively. The 50-50 criteria were present on day 3 in 10 patients and on day 5 in 13. Ten patients (10, 6%) died in ICU. Survivors with these criteria were characterized by early aggressive support including reoperation and/or liver assist system. Nonsurvivors were more often cirrhotic, had significantly higher SAPS II and more frequently postoperative prolonged mechanical ventilation. The 50-50 criteria on days 3 and 5 were predictors of death on multivariate analysis [OR (95% CI): 12.7 (2.3-71.4), OR (95% CI): 29.4 (4.9-167), respectively]. After hepatic resection, results of this prospective study validate the 50-50 criteria as a predictive factor of mortality in ICU on both days 3 and 5. These criteria allow an early diagnosis of postoperative liver failure, which may contribute to reduce mortality in ICU patients after hepatectomy.Keywords
This publication has 12 references indexed in Scilit:
- Percutaneous Transhepatic Portography for the Treatment of Early Portal Vein Thrombosis After SurgeryCardioVascular and Interventional Radiology, 2007
- Predictive Indices of Morbidity and Mortality After Liver ResectionAnnals of Surgery, 2006
- Contrast-Enhanced Versus Conventional and Color Doppler Sonography for the Detection of Thrombosis of the Portal and Hepatic Venous SystemsAmerican Journal of Roentgenology, 2006
- The value of residual liver volume as a predictor of hepatic dysfunction and infection after major liver resectionGut, 2005
- Early goal-directed therapy: An evidence-based reviewCritical Care Medicine, 2004
- Classification of Surgical ComplicationsAnnals of Surgery, 2004
- Risk factors for perioperative morbidity and mortality after extended hepatectomy for hepatocellular carcinomaBritish Journal of Surgery, 2002
- Postoperative liver failure after major hepatic resection for hepatocellular carcinoma in the modern era with special reference to remnant liver volumeJournal of the American College of Surgeons, 1999
- A simulation study of the number of events per variable in logistic regression analysisJournal of Clinical Epidemiology, 1996
- A New Simplified Acute Physiology Score (SAPS II) Based on a European/North American Multicenter StudyJAMA, 1993