Re-Rising of Total Bilirubin Level after Postoperative Day 3 (The V Pattern) Predicting Liver Failure and Survival of Patients who Underwent Hepatectomy for Cholangiocarcinoma

Sawangkajohn, Weerin; Luvria, Vor; Leeratanakachorn, Natwutpong; Tipwaratorn, Theerawee; Theerakul, Suapa; Jarearnrat, Apiwat; Titapun, Attapol; Srisuk, Tharatip; Pugkhem, Ake; Khuntikeo, Narong; Bhudhisawasdi, Vajarabhongsa; Kamsa‐ard, Supot

doi:10.31557/apjcp.2020.21.12.3573

Cited by 4 publications

(1 citation statement)

References 16 publications

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“…An observational study showed that the mortality rate was significantly higher in patients whose blood bilirubin level peaked 3.5 days after cardiovascular surgery than that in patients whose blood bilirubin level peaked earlier [ 10 ]. Similar findings have been reported for the blood bilirubin level following surgery for biliary tract cancer [ 11 ]. AKI and liver dysfunction have recently been linked to increased risk of bleeding and death.…”

Section: Introductionsupporting

confidence: 89%

Hepatic function markers as prognostic factors in patients with acute kidney injury undergoing continuous renal replacement therapy

Nishino,

Kubota,

Kashiwagi

et al. 2024

Renal Failure

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Acute kidney injury (AKI) requiring continuous renal replacement therapy (CRRT), secondary to cardiovascular disease and sepsis, is associated with high in-hospital mortality. Although studies have examined cardiovascular disease and sepsis in AKI, the association between AKI and hepatic functional impairment remains unclear. We hypothesized that hepatic function markers would predict mortality in patients undergoing CRRT. We included 1,899 CRRT patients from a multi-centre database. In Phase 1, participants were classified according to the total bilirubin (T-Bil) levels on the day of, and 3 days after, CRRT initiation: T-Bil < 1.2, 1.2 ≤ T-Bil < 2, and T-Bil ≥ 2 mg/dL. In Phase 2, propensity score matching (PSM) was performed to examine the effect of a T-Bil cutoff of 1.2 mg/dL (supported by the Sequential Organ Failure Assessment score); creating two groups based on a T-Bil cutoff of 1.2 mg/dL 3 days after CRRT initiation. The primary endpoint was total mortality 90 days after CRRT initiation, which was 34.7% ( n = 571). In Phase 1, the T-Bil, aspartate transaminase (AST), alanine transaminase (ALT), and AST/ALT (De Ritis ratio) levels at CRRT initiation were not associated with the prognosis, while T-Bil, AST, and the De Ritis ratio 3 days after CRRT initiation were independent factors. In Phase 2, T-Bil ≥1.2 mg/dL on day 3 was a significant independent prognostic factor, even after PSM [hazard ratio: 2.41 (95% CI; 1.84-3.17), p < 0.001]. T-Bil ≥1.2 mg/dL 3 days after CRRT initiation predicted 90-day mortality. Changes in hepatic function markers in acute renal failure may enable stratification of high-risk patients.

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Section: Introductionsupporting

confidence: 89%

Hepatic function markers as prognostic factors in patients with acute kidney injury undergoing continuous renal replacement therapy

Nishino,

Kubota,

Kashiwagi

et al. 2024

Renal Failure

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A Systematic Review and Meta‐Analysis of Oncologic Liver Resections in Low‐ and Middle‐Income Countries: Opportunities to Improve Evidence and Outcomes

Khan,

Mahmud,

Fatimi

et al. 2024

Journal of Surgical Oncology

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BackgroundPatients in low‐ and middle‐income countries (LMICs) are disproportionately affected by liver cancers but there is a lack of understanding of their postoperative outcomes. This study aimed to review the current status of research in LMICs regarding outcomes after oncologic hepatectomy and synthesize the data reported in the literature.MethodsThe PubMed, Scopus, Embase, Web of Science, and World Health Organization (WHO) Global Index Medicus databases were searched from database inception to May 26th, 2022. Studies that reported outcomes after oncologic hepatectomy in LMIC settings were eligible for inclusion. Two independent reviewers performed record screening and data extraction. Risk of bias assessment was performed using the National Institutes of Health Study Quality Assessment tools. Pooled results with 95% confidence intervals (95% CIs) were calculated using a random effects model.ResultsOne hundred and thirty‐five studies and 16 985 patients were included. Most studies were of a “fair” quality. Two studies described pediatric patients. Only one study was from a low‐income country and most African regions were not represented. The rates of major and minor complications were 11% and 27%, respectively, while 30‐ and 90‐day mortality rates were 2% and 3% each. Postoperative liver failure (8%), surgical site infections (6%), and bile leaks (6%) were common complications.ConclusionsThis review indicates a dearth of data from LMICs on outcomes after hepatectomy, particularly from African regions and low‐income countries.

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Predictors of Post-Hepatectomy Liver Failure in Klatskin Tumors: The Role of Preoperative Glucose, Future Liver Remnant to Spleen Ratio, and Early Bilirubin Monitoring

Kim,

Ku,

Moon

et al. 2024

Diagnostics

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Background: Post-hepatectomy liver failure (PHLF) is a serious complication following hepatic resection for Klatskin tumors, significantly affecting patient prognosis. Identifying reliable preoperative and early postoperative predictors of PHLF can help optimize patient outcomes and guide surgical planning. Method: We conducted a retrospective review of 34 patients who underwent hemi-hepatectomy for extrahepatic cholangiocarcinoma at Kosin University Gospel Hospital between April 2019 and April 2024, and at Chonnam National University Hwasun Hospital between September 2017 and April 2024. Demographics, laboratory data, and volumetric measurements including spleen volume, were analyzed to assess their roles in predicting PHLF. Logistic regression and receiver operating characteristic (ROC) curve analyses were performed to evaluate the predictive value of these factors. Results: Elevated preoperative glucose levels and reduced future liver remnant to spleen ratio (FLR/SV) were significantly associated with an increased risk of PHLF. Additionally, elevated postoperative day 1 total bilirubin (POD 1 TB) was identified as a key postoperative predictor of PHLF. Multivariable analysis confirmed the significance of these factors, with FLR/SV, preoperative glucose, and POD 1 TB demonstrating good discriminative ability in ROC analysis, with AUC values of 0.779, 0.782, and 0.786 respectively. Conclusion: Preoperative glucose control, evaluation of FLR/SV, and early postoperative monitoring of TB are useful for improving outcomes in patients undergoing major hepatectomy for Klatskin tumors.

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Re-Rising of Total Bilirubin Level after Postoperative Day 3 (The V Pattern) Predicting Liver Failure and Survival of Patients who Underwent Hepatectomy for Cholangiocarcinoma

Cited by 4 publications

References 16 publications

Hepatic function markers as prognostic factors in patients with acute kidney injury undergoing continuous renal replacement therapy

Hepatic function markers as prognostic factors in patients with acute kidney injury undergoing continuous renal replacement therapy

A Systematic Review and Meta‐Analysis of Oncologic Liver Resections in Low‐ and Middle‐Income Countries: Opportunities to Improve Evidence and Outcomes

Predictors of Post-Hepatectomy Liver Failure in Klatskin Tumors: The Role of Preoperative Glucose, Future Liver Remnant to Spleen Ratio, and Early Bilirubin Monitoring

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