The value of indocyanine green clearance assessment to predict postoperative liver dysfunction in patients undergoing liver resection

Christoph Schwarz,Patrick Starlinger,Klaus Kaczirek,Martina Mittlböck,Stephanie Kampf,Fabian Fitschek,Immanuel Plass,Stefan Stremitzer,Martin Bodingbauer,Antonia Punzengruber,Ulrika Asenbaum

doi:10.1038/s41598-019-44815-x

Christoph Schwarz, Patrick Starlinger + Show 9 more

Open Access

https://doi.org/10.1038/s41598-019-44815-x

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Abstract

Postoperative liver dysfunction remains a major concern following hepatic resection. In order to identify patients who are at risk of developing liver dysfunction, indocyanine green (ICG) clearance has been proposed to predict postoperative liver function. All patients who underwent liver resection at the Medical University Vienna, Austria between 2006 and 2015 with preoperative ICG clearance testing (PDR, R15) were analyzed in this study. Postoperative liver dysfunction was analyzed as defined by the International Study Group of Liver Surgery. Overall, 698 patients (male: 394 (56.4%); female: 304 (43.6%)) with a mean age of 61.3 years (SD: 12.9) were included in this study, including 313 minor liver resections (44.8%) and 385 major liver resections (55.2%). One hundred and seven patients developed postoperative liver dysfunction after liver resection (15.3%). Factors associated with liver dysfunction were: male sex (p = 0.043), major liver resection (p < 0.0001), and preoperative ICG clearance (PDR (p = 0.002) and R15 (p < 0.0001)). Notably ICG clearance was significantly associated with liver dysfunction in minor and major liver resections respectively and remained a predictor upon multivariable analysis. An optimal cut-off for preoperative ICG clearance to accurately predict liver dysfunction was PDR < 19.5%/min and R15 > 5.6%. To the best of our knowledge, this is the largest study analyzing the predictive value of preoperative ICG clearance assessment in patients undergoing liver resection. ICG clearance is useful to identify patients at risk of postoperative liver dysfunction.

Highlights

Liver resection has become the treatment of choice for a wide range of benign and malignant disease entities
In liver resection Indocyanine green (ICG) clearance has been proposed to define patients, who are at risk of developing postoperative liver dysfunction[13,14] or surgical complications[15]
Data on the value of preoperative ICG clearance testing to predict the development of postoperative liver dysfunction are scarce and studies are limited to small patient numbers

Summary

Methods

This is a retrospective study investigating the predictive value of ICG clearance testing with respect to postoperative outcome after liver resection. All patients with available preoperative ICG clearance testing results who underwent elective liver resection of at least one segment between January 2005 and December 2016 were included in this analysis. Overall 1008 patients underwent hepatic resection within the study period and preoperative ICG clearance testing results were available in 698 patients (63.2%). Patients received 0.25 mg/kg ICG intravenously on the day before the liver resection. Results are presented with odds ratios (OR) and corresponding 95% confidence intervals (95% CI) For this IGG clearance were log-transformed with a basis of 10. Survival probabilities were calculated using a Kaplan-Meier-analysis and group comparison was performed using a log-rank test. Statistical analysis was performed using GraphPad Prism,.

Results

Discussion

Conclusions