CLINICAL PREDICTORS OF ACUTE-ON-CHRONIC LIVER FAILURE IN SURGICAL PRACTICE OF LIVER CIRRHOSIS PATIENTS

Abstract

Objective: to determine pre-operative clinical predictors of acute-on-chronic liver failure (ACLF) in case of surgical treatment of liver cirrhosis patients. Materials and methods. 137 patients after surgery with liver cirrhosis underwent a comprehensive multifactorial assessment of the liver function. Distal splenorenal anastomosis by Warren method was performed in 84 (61,31%) patients, extra-peritonization of the right liver lobe followed by intra-operational or segmental laser radiation of its surface was performed in 32 (23,36%) patients, and in 21 (15,33%) cases the left gastric artery and vein and splenic artery were ligated. The age of patients ranged from 9 to 66 years. Clinical, biochemical, instrumental and morphological examinations were made before surgery, mathematic analysis was applied. Results and conclusions. ACLF was found to complicate the early post-operative period in 33,57% patients with liver cirrhosis causing lethal outcome with 56,52% of rate. In patients with liver cirrhosis biochemical predictors promoting development of post-operative ACLF are: the content of the total bilirubin, urea and creatinine in the blood serum, AsAT and AlAT ratio. The diagnostic criteria Child-Turcotte-Pugh enable to assess the liver functional state and can be used in clinical practice while choosing therapeutic tactics, but they are not enough sensitive to prognosticate ACLF. The possibility of ACLF development during post-operative period is the highest in patients with liver cirrhosis complicated with ascites and bleeding from the varicose veins of the esophagus and/or stomach. Detection of morphological manifestation of liver cirrhosis by the results of morphometric examinations of the liver biopsy material most accurately enables to prognosticate ACLF development after surgery. A number of ultrasound signs available in liver cirrhosis patients such as the diameter of the portal vein more than 1,4 cm, linear speed of the blood flow in the portal vein less than 12 cm/s and portal stagnation index more than 0,13 cm х s are indicative of a high probability of ACLF development at the early post-operative period.