Comparison between preoperative two-dimensional shear wave elastography and indocyanine green clearance test for prediction of post-hepatectomy liver failure

Qiu, Tingting; Fu, Rong; Ling, Wenwu; Li, Jiawu; Song, Jiulin; Wu, Zhenru; Shi, Yujun; Zhou, Yuqing; Luo, Yan

doi:10.21037/qims-20-640

Cited by 10 publications

(7 citation statements)

References 29 publications

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“…Findings from earlier studies suggest a relevant predictive potential either at study inclusion or ICU admission: Oellerich et al [25] observed effective survival prediction in severe liver cirrhosis using ICG clearance at study inclusion. Similarly, Qui et al [26] linked ICG clearance with post-hepatectomy liver failure (PHLF), correlating the test with PHLF occurrence and severity. Ishikawa et al [27] demonstrated its predictive ability for post-operative complications in patients with hepatocellular carcinoma undergoing hepatectomy.…”

Section: Discussionmentioning

confidence: 99%

The Prognostic Value of a Liver Function Test Using Indocyanine Green (ICG) Clearance in Patients with Multiple Organ Dysfunction Syndrome (MODS)

Haertel,

Nuding,

Reisberg

et al. 2024

JCM

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: ICG clearance was measured in 44 patients of the MODIFY trial cohort, of which 9 patients had cMODS (20%) and 35 patients had sMODS (80%). Mean age: 59.7 ± 16.5 years; 31 patients were men; mean APACHE II score: 33.6 ± 6.3; 28-day mortality was 47.7%. Liver function was reduced in the total cohort as measured by a PDR of 13.4 ± 6.3%/min At baseline, there were no relevant differences between survivors and non-survivors regarding ICG clearance (PDR: 14.6 ± 6.1%/min vs. 12.1 ± 6.5%/min; p = 0.21). However, survivors showed better liver function than non-survivors after 96 h (PDR: 21.9 ± 6.3%/min vs. 9.2 ± 6.3%/min, p < 0.05). Consistent with these findings, survivors but not non-survivors show a significant improvement in the PDR (7.3 ± 6.3%/min vs. −2.9 ± 2.6%/min; p < 0.01) within 96 h. In accordance, receiver-operating characteristic curves (ROCs) at 96 h but not at baseline show a link between the PDR and 28-day mortality (PDR at 96 h: AUC: 0.87, 95% CI: 0.76–0.98; p < 0.01. Conclusions: In our study, we found that ICG clearance at baseline did not provide prognostic information in patients in the early stages of MODS despite being reduced in the total cohort. However, improvement of ICG clearance 96 h after ICU admission is associated with reduced 28-day mortality.

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Section: Discussionmentioning

confidence: 99%

The Prognostic Value of a Liver Function Test Using Indocyanine Green (ICG) Clearance in Patients with Multiple Organ Dysfunction Syndrome (MODS)

Haertel,

Nuding,

Reisberg

et al. 2024

JCM

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“…The gut microbiome is considered a "hidden organ" that regulates human health, including liver function. It seems to play a complex role in the progression of liver diseases, and thus, identifying any alterations in intestinal microbial composition might help to establish novel therapeutic targets (38). Extended hepatectomy is a well-established risk factor for PHLF.…”

Section: Discussionmentioning

confidence: 99%

Gut microbiome dysbiosis in patients with hepatitis B virus-related hepatocellular carcinoma after extended hepatectomy liver failure

Peng¹,

Xu²,

Zeng³

et al. 2022

Ann Transl Med

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Background: Hepatitis B virus-related hepatocellular carcinoma (B-HCC) negatively affects the gut microbiome. This study aimed to investigate the gut microbiome profiles and functions post-hepatectomy liver failure (PHLF) after extended hepatectomy (e-PHLF) to obtain valuable insights, identify potential diagnostic biomarkers, and assist in the treatment of this disease.Methods: B-HCC patients who underwent extended hepatectomy were consecutively recruited and divided into Group A (n=15) and Group B (n=15) based on the presence and absence of e-PHLF, respectively.The relationships between gut microbiota and extended hepatectomy liver failure were explored using 16S ribosomal RNA (16S rRNA) gene sequencing data.Results: Following extended hepatectomy, the α-diversity of Group A was significantly higher than that of Group B (Shannon P=0.034 or Simpson P=0.031), and the β-diversity differed significantly between Groups A and B (P=0.004, R=0.100). At the genus level, 10 bacterial genera (Bacteroides, Pantoea, Methylobacterium-Methylorubrum, Inquilinus, Mycobacterium, Allisonella, Helicobacter, GCA-900066575, IS-44, and Faecalibacterium) were significantly enriched in Group A, whereas five genera (Papillibacter, Scardovia, Turicibacter, Catabacter, and Senegalimassilia) were significantly enriched in Group B. The highly abundant genera Bacteroides, Pantoea, Faecalibacterium, and Turicibacter participated in multiple amino acid metabolism pathways, organic acid metabolism pathways, pyrimidine metabolism pathways, palmitate biosynthesis, and stearate biosynthesis. Redundancy analysis showed that four environmental factors (total bilirubin, international normalized ratio, prealbumin, and albumin) were significantly correlated with intestinal microorganisms. The formation of interaction networks between different gut microbiomes revealed important correlations between the gut microbiome, and there was a significant correlation between the highly abundant gut microbiome and main functions. Conclusions:The gut microbiota characteristics in B-HCC patients after extended hepatectomy liver failure might allow for the use of non-invasive biomarkers for disease diagnosis and treatment.

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“…However, the impact of the degrees of cirrhosis on prediction of PHLF needs to be further studied. Several predictive models of PHLF have been reported on cirrhotic patients with HCC, including the model for endstage liver disease (MELD) score, hepatic venous pressure gradient (HVPG), indocyanine green (ICG) clearance, and liver stiffness (LS) (15)(16)(17). However, all these predictive models are not effective enough in preventing deaths from PHLF in HCC patients who undergo hepatectomy with a background of cirrhosis.…”

Section: Introductionmentioning

confidence: 99%

A combined pre- and intra-operative nomogram in evaluation of degrees of liver cirrhosis predicts post-hepatectomy liver failure: a multicenter prospective study

Liang¹,

Zhang²,

Li³

et al. 2024

Hepatobiliary Surg Nutr

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Background: Adequate evaluation of degrees of liver cirrhosis is essential in surgical treatment of hepatocellular carcinoma (HCC) patients. The impact of the degrees of cirrhosis on prediction of posthepatectomy liver failure (PHLF) remains poorly defined. This study aimed to construct and validate a combined pre-and intra-operative nomogram based on the degrees of cirrhosis in predicting PHLF in HCC patients using prospective multi-center's data.Methods: Consecutive HCC patients who underwent hepatectomy between May 18, 2019 and Dec 19, 2020 were enrolled at five tertiary hospitals. Preoperative cirrhotic severity scoring (CSS) and intra-operative direct liver stiffness measurement (DSM) were performed to correlate with the Laennec histopathological grading system. The performances of the pre-operative nomogram and combined pre-and intra-operative nomogram in predicting PHLF were compared with conventional predictive models of PHLF.Results: For 327 patients in this study, histopathological studies showed the rates of HCC patients with no, mild, moderate, and severe cirrhosis were 41.9%, 29.1%, 22.9%, and 6.1%, respectively. Either CSS or DSM was closely correlated with histopathological stages of cirrhosis. Thirty-three (10.1%) patients developed PHLF. The 30-and 90-day mortality rates were 0.9%. Multivariate regression analysis showed four preoperative variables [HBV-DNA level, ICG-R15, prothrombin time (PT), and CSS], and one intra-operative variable (DSM) to be independent risk factors of PHLF. The pre-operative nomogram was constructed based Highlight box Key findings• Four pre-operative variables (HBV-DNA level, ICG-R15, prothrombin time, and CSS), and one intra-operative variable (DSM) were independent risk factors of post-hepatectomy liver failure (PHLF). • Both the pre-operative nomogram and the combined pre-and intra-operative nomogram were efficient in predicting PHLF. What is known and what is new?• What is known: Adequate evaluation of degrees of liver cirrhosis is essential in surgical treatment of HCC patients. • What is new: This study constructed and validated a combined pre-and intra-operative nomogram based on the degrees of cirrhosis in predicting PHLF in HCC patients. What is the implication, and what should change now?• The pre-operative model should be used pre-operatively to identify individuals who are at high risks of developing PHLF. The combined pre-and intra-operative model should be used to make a final decision on whether to continue with hepatectomy or to carry out a lesser extent of hepatectomy.on these four pre-operative variables together with total bilirubin. The combined pre-and intra-operative nomogram was constructed by adding the intra-operative DSM. The pre-operative nomogram was better than the conventional models in predicting PHLF. The prediction was further improved with the combined pre-and intra-operative nomogram. Conclusions:The combined pre-and intra-operative nomogram further improved prediction of PHLF when compared with the pre-operative nomogram.

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Comparison between preoperative two-dimensional shear wave elastography and indocyanine green clearance test for prediction of post-hepatectomy liver failure

Cited by 10 publications

References 29 publications

The Prognostic Value of a Liver Function Test Using Indocyanine Green (ICG) Clearance in Patients with Multiple Organ Dysfunction Syndrome (MODS)

The Prognostic Value of a Liver Function Test Using Indocyanine Green (ICG) Clearance in Patients with Multiple Organ Dysfunction Syndrome (MODS)

Gut microbiome dysbiosis in patients with hepatitis B virus-related hepatocellular carcinoma after extended hepatectomy liver failure

A combined pre- and intra-operative nomogram in evaluation of degrees of liver cirrhosis predicts post-hepatectomy liver failure: a multicenter prospective study

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