Value Of The Conventional Liver Function Tests In The Assessment Of Hepatic Reserve

Purpose:To evaluate the conventional liver function tests in the assessment of hepatic reserve,to study the dangerous factors before hepatectomy,and try to find a method to assess the hepatic reserve and predict the postoperative hepatic decompensation (PHD) effectively and conveniently.Methods:We reviewed 562 Child-Pugh A patients,who underwent hepatectomy because of hepatocellular carcinoma in Zhongshan Hospital Fudan University between July 1st 2007 to December 31th 2007,studying the dangerous factors by logistic univariate and multivariate analysis,Receiver operating characteristic(ROC) curve was used to analysis the cut-off of dangerous factors predicting the hepatic decompensation.Results:The incidence of PHD was 5.16%,and the mortality was 1.25%due to hepatic failure.The preoperative total bilirubin(TB),albumin/globulin,alkaline phosphatase,prealbumin(PA) and the size of cirrhotic nodules were found to be the dangerous factors by logistic univariate analyse(P＜0.05),preoperative hyperbilirubin and hypoprealbumin were independent dangerous factors of PHD by logistic multivariate analysis;ROC analysis revealed the cut-offs predicting PHD were preoperative PA 0.14 g/L(sensitivity:41.4%;specificity:83.1%) and PA on postoperative day(POD)1 0.12 g/L(sensitivity:62.1%;specificity:70.3%).The incidence of PHD was 2.55% when TB＜20.4μmol/L and PA≥0.14 g/L compared with 10.24%when TB≥20.4umol/L or PA＜0.14g/L(odds ratio[OR]=4.408,P＜0.001,and 16.00%when TB≥20.4umol/L and PA＜0.14 g/L(OR=7.276,P=0.002).Sensitivity was 65.5% and specificity was 71.7%when TB≥20.4μmol/L and/or PA＜0.14 g/L.The incidence of PHD was 10.23%when PA＜0.12 g/L on POD1 compared with 85% when PA≥0.12 g/L on POD1(OR=3.884,P=0.001).Cirrhotic nodules＞3mm was found to be the unique dangerous factor of the death due to hepatic failure by logistic univariate analysis,(OR=9.275,P=0.040). Conclusions:1.The Child-Pugh A patient will recovery well when TB＜20.4μmol/L and PA≥0.14 g/L before hepatectomy;2.When PA＜0.12 g/L on POD1,more attention should be paid to prevent the hepatic decompensation.3.Liver cirrhosis nodules＞3mm was the unique dangerous factor of death due to hepatic failure in our study.