Arnaud  Pontallier,Christophe Laurent,Etienne  Buscail,Fabrice Muscari,Jean-Philippe  Adam,Laurence  Chiche,Sandrine  Dabernat,Véronique  Vendrely,
Hepatic marker combination provides relevant score to predict severe
morbidity after colorectal metastases-related major hepatectomy
Journal of Surgical Oncology
2018
2674-3000
http://dx.doi.org/10.31487/j.JSO.2018.01.004
https://www.sciencerepository.org/early-biological-predicting-score-of-post-hepatectomy-severe-morbidity_JSO-1-104 
Abstract: Background and objectives: After hepatic resection, liver failure is not diagnosed until the postoperative
day-5. The aim was to identify a biomarker predictive of severe morbidity, the day after major hepatectomy.
Methods: This retrospective study included patients undergoing major hepatectomy for colorectal
metastases, plasma hepatic marker concentrations being determined at postoperative day-one. Outcomes
were 30-day severe morbidity (Dindo III to V) and grade C post-hepatectomy liver failure.
Results: A total of 433 patients were included. Thirty-day severe morbidity, 90-day mortality and grade-C
post-hepatectomy liver failure rates were 15.5%, 2.5% and 2.5% respectively. Using cut-offs determined
by receiver operating characteristic curves the association of serum bilirubin ≥ 2.1 mg/dL (≥ 2 N) and
aspartate-amino-transferase ≥ 450 IU/L (≥ 10 N) was selected for the best biochemical predictors of severe
morbidity (sensitivity 38%, specificity 94%) and post-hepatectomy failure (sensitivity 100%, specificity
91%). In multivariate analysis, this score was independently associated with severe morbidity (HR = 5.98,
95% IC 2.65-13.89; P < 0.0001)
Conclusions: The association of plasma bilirubin ≥ 2.1 mg/dL and aspartate-amino-transferase ≥ 450 IU/L
is identified as a relevant predictor of severe morbidity and post-hepatectomy failure as early as the first
postoperative day after major hepatectomy for colorectal metastases.Keywords: Hepatectomy, Metastases, liver failure, predictive marker, post-operative morbidity