Assessment of liver function by prognostic score after relief of obstructive jaundice

Abstract

To evaluate liver function reserve after relief of obstructive jaundice, we investigated the correlation between outcome after hepatectomy and 16 perioperative clinical factors in 13 patients with hilar bile duct carcinoma. The patients were classified into two groups according to the presence or absence of postoperative hepatic failure, defined as serum total bilirubin level exceeding 10mg/dl. A prognostic score formula was then created retrospectively. Total bilirubin, plasma retention rate of indocyanine green at 15 min (ICGR15), bilirubin decrease rate (b value), and duration of operation showed significant inter-group relationships on univariate analysis. By stepwise logistic regression we proposed the following discriminant formula: Prognostic score=−16.155+2.223×(ICGR15) +1.492×(liver resection ratio) +0.807×(b value ×103) With this formula, scores for patients without hepatic failure were 33 or less while those for hepatic failure patients were 68 or more, showing a clear distinction between the groups. Preoperative portal embolization (PE) decreased the mean prognostic score from 101.2 to 81.2, but 3 of 4 patients survived the operation without hepatic failure despite their high prognostic scores. This prognostic score is useful for predicting postoperative hepatic failure in patients with obstructive jaundice. However, further prospective studies are required to confirm the reliability of this formula, and some other mode of prognostic assessment is needed for patients who have preoperative PE.