Abstract
BackgroundThe indocyanine green (ICG) clearance test is the main method of evaluating the liver reserve function before hepatectomy. However, some patients may be allergic to ICG or the equipment of ICG clearance test was lack, leading to be difficult to evaluate liver reserve function. We aim to find an alternative tool to assist the clinicians to evaluate the liver reserve function for those who were allergic to the ICG or lack of equipment before hepatectomy.MethodsWe retrospected 300 patients to investigate the risk factors affecting the liver reserve function and to build an equivalent formula to predict ICG 15 min retention rate (ICG-R15) value.ResultsWe found that the independent risk factors affecting ICG clearance test were total bilirubin, albumin, and spleen-to-non-neoplastic liver volume ratio (SNLR). The equivalent formula of the serological index combining with SNLR was: ICG-R15 = 0.36 × TB (umol/L) − 0.78 × ALB(g/L) + 7.783 × SNLR + 0.794 × PT (s) − 0.016 × PLT(/109) − 0.039 × ALT (IU/L) + 0.043 × AST (IU/L) + 23.846. The equivalent formula of serum index was: ICG-R152 = 24.665 + 0.382 × TB (umol/L) − 0.799 × ALB(g/L) − 0.025 × PLT(/109) + 0.048 × AST(IU/L) − 0.045 × ALT(IU/L). And the area under the ROC curve (AUC) of predicting ICG-R15 ≥ 10% was 0.861 and 0.857, respectively.ConclusionWe found that SNLR was an independent risk factor affecting liver reserve function. Combining with SNLR to evaluate the liver reserve function was better than just basing on serology.
Highlights
The indocyanine green (ICG) clearance test is the main method of evaluating the liver reserve function before hepatectomy
The age, total bilirubin (TB), Alanine aminotransferase (ALT), Aspartate aminotransferase (AST), spleen volume and spleen-to-non-neoplastic liver volume ratio (SNLR) were significantly higher in ICG-R15 ≥ 10% patients than ICGR15 < 10% patients, and the difference was significant
We found that the difference of age, TB, AST, ALT, HGB, White blood cell (WBC), PLT and ALB were not significant after propensity score match (PSM), just only the spleen volume (414.41 ± 210.77 vs 324.82 ± 206.34, p = 0.023) and the SNLR (0.38 ± 0.22 VS 0.30 ± 0.18, p = 0.029) were significant, indicating that the PSM results were credible
Summary
The indocyanine green (ICG) clearance test is the main method of evaluating the liver reserve function before hepatectomy. Some patients may be allergic to ICG or the equipment of ICG clearance test was lack, leading to be difficult to evaluate liver reserve function. We aim to find an alternative tool to assist the clinicians to evaluate the liver reserve function for those who were allergic to the ICG or lack of equipment before hepatectomy. Child–Pugh score system is the most common methods of evaluating the liver function, which is classified by total bilirubin (TB), albumin (ALB), prothrombin time (PT), ascites and psychosis (hepatic encephalopathy HE). There needed an alternative tool to assist surgeons to evaluate the live reverse function, when the patients occurred the adverse reactions or the equipment of ICG clearance test was lack
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