Apparent normobasemia as a negative prognostic sign immediately after hepatectomy

Abstract

The acid-base balance from the postoperative day (POD) 1 to POD 3 after cirrhotic liver resection was investigated in relation to operative outcome by conducting a retrospective study on the changes in arterial ketone body ratio (AKBR), which reflects the hepatic mitochondrial redox state, and arterial blood gas analysis. Patients were grouped according to their outcome: hospital death (HD) and or good outcome, the latter group acting as controls (CTR). Metabolic alkalosis developed in a significant number of the CTR patients (p < 0.01), who had high AKBR values. By contrast, metabolic alkalosis did not develop in the HD group, with significantly lower AKBR (p < 0.001), and there was almost normobasemia. There were no significant differences in the need for mechanical respiratory assistance, the amounts of fresh frozen plasma administered, and renal function test results between the two groups on each of 3 postoperative days. These data indicated that the absence of metabolic alkalosis during the early postoperative days reflects disruption of energy metabolism in the remnant liver, and that the apparent normobasemia is a significant indicator of poor prognosis after cirrhotic liver resection.

Does acid-base equilibrium correlate with remnant liver volume during stepwise liver resection?

“…Although others have reported (4,32) no changes in PCO 2 values after hepatectomy, PCO 2 values in our study were different in the jugular vein and carotid artery after 75% resection. In this study, PO 2 increased after every step of resection in the arteries and decreased slightly in the veins.…”

“…Although the RLV is in a hyperdynamic state and therefore has a higher O 2 demand, it receives less O 2 because arterial perfusion decreases (3,4,6,7,16,22). Insuf-ficient oxygen supply to hepatocytes reduces mitochondrial oxidative phosphorylation (3,6,18,26), which inhibits the Krebs (tricarboxylic acid) cycle (3,18,20,21,32). Also, metabolic overload of the remnant liver leads to metabolic insufficiency of hepatocytes (3,18,30).…”

“…This increases HCO 3 Ϫ consumption (3,13,22) and causes metabolic acidosis (4,13). A correlation between acidosis and PHLF has already been postulated (4,27,32) but, to the best of our knowledge, has never been studied systematically in large animal or clinical models.…”

“…This leads to hypoxia in the RLV (5,10,31). Low oxygen supply to the remnant liver reduces mitochondrial oxidative phosphorylation in hepatocytes and lowers energy production (6,18,22,32). Consequently, lactate is overproduced, and lactate clearance is decreased.…”

Peri-Operative Care of Patients with Hepatocellular Carcinoma Undergoing Hepatectomy

“…Metabolic acidosis may also occur in the immediate postoperative period [47], Together with hypoglycacmia and impaired sensorium, it indicates hepatic failure and consequently a poor prognosis. Isolated occurrence of metabolic acidosis may be observed in patients with bor derline liver function or with hypothermia secondary to prolonged operation.…”