Correlating MDCT Liver Injury Grade and Clinical Outcome in Patients Without Significant Extra-hepatic Injury

Abstract

The aim of the study was to correlate multi-detector computed tomography (MDCT) grading with clinical severity and outcome in liver trauma patients without significant extrahepatic injury. Over a period of 2years (2011-2013), all patients showing evidence of liver injury on contrast-enhanced CT (CECT) abdomen and without significant extrahepatic trauma were prospectively included in the study. Correlation between the CT injury grade and outcome in terms of mortality, duration of ICU/hospital stay, fluid and blood requirements, need for intervention and complications were assessed. The significance of the difference in mortality, duration of ICU/hospital stay, fluid requirement and blood requirements among the patients with various injury grades was assessed by Kruskal-Wallis test. The significance of the difference in need for intervention and complications among the patients with various injury grades was assessed by Fisher's exact test. A total of 198 patients were found to have evidence of hepatic injury on CECT. Out of 198 patients, 117 had insignificant extrahepatic trauma. The overall mean age for these 117 patients was 25.74 ± 15.53 (age range 2-84years). Death rates according to AAST grades were 0% in grades II and III, 6.89% in grade IV and 9.09% in grade V (p = 0.053). The mean ICU and total hospital stay for grade II was 1.32 and 5.91days, for grade III was 1.76 and 8.48, for grade IV was 2.86 and 10.31days and for grade V was 6.54 and 12days, respectively (p = 0.0001 for ICU, p = 0.0003 for total stay). Mean input and fluid deficit according to various grades were 8634/2607ml for grade II, 9535/2555ml for grade III, 15,549/6242ml for grade IV and 19,958/8280ml for grade V (p value input-0.0016, output-input (fluid deficit)-0.0001). Average unit of RBC and sum of the blood products transfused were 1.73 and 2.26 for grade II, 2.18 and 2.72 for grade III, 3.03 and 6.27 for grade IV, 6.85 and 38.12 for grade V, respectively (p value RBC-0.10, total-0.037). The difference in the need of active surgical/endovascular intervention and complication rates was not significantly higher in higher injury grades. The grading of liver injury based on CECT findings can predict the clinical course in liver trauma patients with insignificant extrahepatic injuries.