| Prognostic criteria for postoperative mortality in 170 patients undergoing major right hepatectomy. | |
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MedLine Citation:
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PMID: 23060396 Owner: NLM Status: In-Data-Review |
Abstract/OtherAbstract:
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BACKGROUND: Postoperative hepatic failure is a dreadful complication after major hepatectomy and carries high morbidity and mortality rates. In this study, we assessed the accuracy of the 50/50 criteria (bilirubin >2.9 mg/dL and international normalized ratio >1.7 on postoperative day 5) and the Mullen criteria (bilirubin peak >7 mg/dL on postoperative days 1-7) in predicting death from hepatic failure in patients undergoing right hepatectomy only. In addition, we identified prognostic factors linked to intra-hospital morbidity and mortality in these patients. METHODS: One hundred seventy consecutive patients underwent major right hepatectomy at a tertiary medical center from 2000 to 2008. Nineteen (11.2%) patients suffered from liver cirrhosis. Univariate and multivariate analyses were performed to identify predictors of intra-hospital mortality, morbidity and death from hepatic failure. RESULTS: The intra-hospital mortality was 6.5% (11/170). Of the six patients who died from hepatic failure, one was positive for the 50/50 criteria, but all six patients were positive for the Mullen criteria. Multivariate analysis showed that male gender, hepatitis C (HCV), hepatocellular carcinoma, postoperative bilirubin >7 mg/dL and ALT<188 U/L on postoperative day 1 were predictive of death from hepatic failure in the postoperative period. Age >65 years, HCV, reoperation, and renal failure were significant predictors of overall intra-hospital mortality on multivariate analysis. CONCLUSIONS: The Mullen criteria were more accurate than the 50/50 criteria in predicting death from hepatic failure in patients undergoing right hepatectomy. A bilirubin peak >7 mg/dL in the postoperative period, HCV positivity, hepatocellular carcinoma, and an ALT level <188 U/L on postoperative day 1 were associated with death from hepatic failure in our patient population. |
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Authors:
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Filippo Filicori; Xavier M Keutgen; Matteo Zanello; Giorgio Ercolani; Salomone Di Saverio; Federico Sacchetti; Antonio Daniele Pinna; Gian Luca Grazi |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Hepatobiliary & pancreatic diseases international : HBPD INT Volume: 11 ISSN: 1499-3872 ISO Abbreviation: HBPD INT Publication Date: 2012 Oct |
Date Detail:
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Created Date: 2012-10-12 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 101151457 Medline TA: Hepatobiliary Pancreat Dis Int Country: China |
Other Details:
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Languages: eng Pagination: 507-12 Citation Subset: IM |
Affiliation:
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General Surgery and Transplant Unit, Department of General Surgery and Organ Transplantation, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy. fif2003@med.cornell.edu. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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