An ordinal model to predict the risk of symptomatic liver failure in patients with cirrhosis undergoing hepatectomy

作者：Mathieu Prodeau, Élodie Drumez, Alain Duhamel, Éric Vibert, Olivier Farges, Guillaume Lassailly, Jean‐Yves Mabrut, Jean Hardwigsen, Jean‐Marc Regimbeau, Olivier Soubrane, René Adam, François-René Pruvot, Emmanuel Boleslawski · 发表于：Journal of Hepatology · 年份：2019 · DOI：10.1016/j.jhep.2019.06.003 · 被引用次数：101 · 研究领域：Hepatocellular Carcinoma Treatment and Prognosis、Liver Disease and Transplantation、Organ Transplantation Techniques and Outcomes

BACKGROUND & AIMS: Selection criteria for hepatectomy in patients with cirrhosis are controversial. In this study we aimed to build prognostic models of symptomatic post-hepatectomy liver failure (PHLF) in patients with cirrhosis. METHODS: This was a cohort study of patients with histologically proven cirrhosis undergoing hepatectomy in 6 French tertiary care hepato-biliary-pancreatic centres. The primary endpoint was symptomatic (grade B or C) PHLF, according to the International Study Group of Liver Surgery's definition. Twenty-six preoperative and 5 intraoperative variables were considered. An ordered ordinal logistic regression model with proportional odds ratio was used with 3 classes: O/A (No PHLF or grade A PHLF), B (grade B PHLF) and C (grade C PHLF). RESULTS: Of the 343 patients included, the main indication was hepatocellular carcinoma (88%). Laparoscopic liver resection was performed in 112 patients. Three-month mortality was 5.25%. The observed grades of PHLF were: 0/A: 61%, B: 28%, C: 11%. Based on the results of univariate analyses, 3 preoperative variables (platelet count, liver remnant volume ratio and intent-to-treat laparoscopy) were retained in a preoperative model and 2 intraoperative variables (per protocol laparoscopy and intraoperative blood loss) were added to the latter in a postoperative model. The preoperative model estimated the probabilities of PHLF grades with acceptable discrimination (area under the receiver-operating characteristic curve [AUC]...