Abstract
BackgroundPatients undergoing liver resection are at risk for intraoperative hyperglycemia and acute hyperglycemia is known to induce hepatocytes injury. Thus, we aimed to evaluate whether intraoperative hyperglycemia during liver resection is associated with the extent of hepatic injury.MethodsThis 1 year retrospective observation consecutively enrolled 85 patients undergoing liver resection for hepatocellular carcinoma. Blood glucose concentrations were measured at predetermined time points including every start/end of intermittent hepatic inflow occlusion (IHIO) via arterial blood analysis. Postoperative transaminase concentrations were used as surrogate parameters indicating the extent of surgery-related acute hepatocytes injury.ResultsThirty (35.5%) patients developed hyperglycemia (blood glucose > 180 mg/dl) during surgery. Prolonged (≥ 3 rounds) IHIO (odds ratio [OR] 7.34, P = 0.004) was determined as a risk factors for hyperglycemia as well as cirrhosis (OR 4.07, P = 0.022), lower prothrombin time (OR 0.01, P = 0.025), and greater total cholesterol level (OR 1.04, P = 0.003). Hyperglycemia was independently associated with perioperative increase in transaminase concentrations (aspartate transaminase, β 105.1, standard error 41.7, P = 0.014; alanine transaminase, β 81.6, standard error 38.1, P = 0.035). Of note, blood glucose > 160 or 140 mg/dl was not associated with postoperative transaminase concentrations.ConclusionsHyperglycemia during liver resection might be associated with the extent of hepatocytes injury. It would be rational to maintain blood glucose concentration < 180 mg/dl throughout the surgery in consideration of parenchymal disease, coagulation status, lipid profile, and the cumulative hepatic ischemia in patients undergoing liver resection for hepatocellular carcinoma.
Highlights
The liver is one of principal organs for glycemic homoeostasis
A recent animal study in rats has demonstrated that acute hyperglycemia for a transient period amplifies hepatic ischemia reperfusion injury, which suggests the importance of acute hyperglycemia which occurs during surgery when hepatic ischemia injury may be accompanied [11]
Subjects Eight-five patients who underwent liver resection for hepatocellular carcinoma (HCC) between July 2011 and June 2012 who met the inclusion criteria were enrolled into the study in a consecutive manner
Summary
The liver is one of principal organs for glycemic homoeostasis. patients undergoing liver resection are at risk of hyperglycemia due to procedures incurring the liver and functional hepatic tissue loss [1]. Accumulating evidence suggests that the effect of perioperative hyperglycemia vary by surgery and respective importance of intra-/postoperative hyperglycemia is different [3,4,9]. Few studies have evaluated the effects of perioperative hyperglycemia mainly focusing on the extent of hepatic injury. The relationship between intraoperative hyperglycemia and hepatic injury has never been assessed in clinical liver resection. The objectives of this study were: (i) to evaluate the contributors for hyperglycemia during liver resection and (ii) to assess the relationship between intraoperative hyperglycemia and hepatocytes injury. Patients undergoing liver resection are at risk for intraoperative hyperglycemia and acute hyperglycemia is known to induce hepatocytes injury. We aimed to evaluate whether intraoperative hyperglycemia during liver resection is associated with the extent of hepatic injury
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