Avaliação de critério pós-operatório de insuficiência hepática como fator prognóstico de mortalidade após hepatectomia: importância da alteração combinada do tempo de protrombina e da bilirrubina sérica / Evaluation of postoperative criteria of liver failure as a prognostic factor of mortality after hepatectomy: importance of the combined alteration of prothrombin time and serum bilirubin

AUTOR(ES)
DATA DE PUBLICAÇÃO

2006

RESUMO

INTRODUCTION. Definition of postoperative liver failure (PLF) is not standardized, rendering complex the comparison of novelties in liver procedures and also the use of possible postoperative therapeutic interventions in due time. METHODS. Between 1998 and 2002, 775 elective liver resections, whence 531 (69%) were for malignancies and 464 (60%) for major resections, were included in a prospective database. The non- tumorous hepatic parenchima was abnormal in 330 patients (43%) including steatosis >30% in 107 (14%), non-cirrhotic fibrosis in 237 (43%) and cirrhosis in 94 (12%). The clinical impact of Prothrombin Time (PT) <50% and Serum Bilirubin (SB) >50µmol/L (3 mg/dl) (50-50 criteria) on postoperative days (POD) 1, 3, 5 and 7 was analyzed. RESULTS. Kinetic of postoperative PT and SB were different. Lowest PT levels were on POD1 and the peak of SB was on POD 3. The tendency to return to preoperative values of these two biochemical factors was clearly affirmed on POD 5. Operative mortality was 3.4% (26 patients), including 21 (81%) cases with abnormal liver parenchyma and 20 (77%) following major hepatectomies. Mortality rate was increased in patients with PT <50% or SB >50µmol/L (3mg/dl). The conjunction of PT <50% and SB >50µmol/L (3 mg/dl) on POD 5 was a strong predictive factor of increased mortality, which reached 59%. CONCLUSIONS We found that after postoperative day 5, the association of PT >50% and SB >50µml/L (3 mg/dl) (50-50 criteria) was a simple and accurate predictor of mortality after hepatectomy. These results allow us to propose this criteria as a definition of postoperative liver failure.

ASSUNTO(S)

complicações pós-operatórias bilirubin/diagnostic use fatores de risco bilirrubina/uso diagnóstico risk factors liver function tests/mortality hepatectomia/mortalidade testes de função hepática/mortalidade insuficiência hepática postoperative complications hepatectomy/mortality prothrombine time/diagnostic use liver failure tempo de protrombina/uso diagnóstico

ACESSO AO ARTIGO

Documentos Relacionados