Predictors of Liver Failure in Non‐Cirrhotic Patients Undergoing Hepatectomy

Abstract

Background Post‐hepatectomy liver failure (PHLF) is associated with high mortality following liver resection. There have been limited studies evaluating predictors of PHLF and clinically significant PHLF in non‐cirrhotic patients. Methods This was a retrospective cohort study using the National Surgical Quality Improvement Program database (NSQIP) to evaluate 8,093 non‐cirrhotic patients undergoing hepatectomy from 2014 to 2018. Primary endpoints were PHLF and clinically significant PHLF (PHLF grade B or C). Results Among all patients, 4.74% (n = 383) developed PHLF and 2.5% clinically significant PHLF (n = 203). The overall 30‐day mortality was 1.35% (n = 109), 11.5% (n = 44) in patients with PHLF, and 19.2% in those with clinically significant PHLF. Factors associated with PHLF were: metastatic liver disease (OR = 1.84, CI = 1.14–2.98), trisectionectomy (OR = 3.71, CI = 2.59–5.32), right total lobectomy (OR = 4.17, CI = 3.06–5.68), transfusions (OR = 1.99, CI = 1.52–2.62), organ/space SSI (OR = 2.84, CI = 2.02–3.98), post‐operative pneumonia (OR = 2.43, CI = 1.57–3.76), sepsis (OR = 2.27, CI = 1.47–3.51), and septic shock (OR = 5.67, CI = 3.43–9.36). Patients who developed PHLF or clinically significant PHLF had 2–threefold increased risk of perioperative mortality. Post‐hepatectomy renal failure (OR = 8.47, CI = 3.96–18.1), older age (OR = 1.04, CI = 1.014–1.063), male sex (OR = 1.83, CI = 1.07–3.14), sepsis (OR = 2.96, CI = 1.22–7.2), and septic shock (OR = 3.92, CI = 1.61–9.58) were independently associated with 30‐mortality in patients with clinically significant PHLF. Conclusion PHLF in non‐cirrhotic patients increased the risk of perioperative mortality and is associated with the extent of hepatectomy and infectious complications. Careful evaluation of the liver remnant, antibiotic prophylaxis, nutritional assessment, and timely management of post‐operative infections could decrease major morbidity and mortality following hepatectomy.

Hepatic failure associated with immune checkpoint inhibitors: An analysis of the Food and Drug Administration Adverse Event Reporting System database

“… 25 , 26 A cohort study that aimed to investigate risk factors for post‐hepatectomy liver failure showed that 4.09% (171/4178) of patients with liver metastases developed liver failure after hepatectomy. 27 However, in our study, only 0.76% (5/654) of patients with hepatic failure developed liver metastases.…”