Using the Comprehensive Complication Index to rethink the ISGLS Criteria for Post-hepatectomy Liver Failure in an International Cohort of Major Hepatectomies.

eScholarship, University of California 2021-12-01

ObjectiveTo compare different criteria for post-hepatectomy liver failure (PHLF) and evaluate the association between International Study Group of Liver Surgery (ISGLS) PHLF and the Comprehensive Complication Index (CCI) and 90-day mortality.Summary background dataPHLF is a serious complication following hepatic resection. Multiple criteria have been developed to characterize PHLF.MethodsAdults who underwent major hepatectomies at twelve international centers (2010-2020) were included. We identified patients who met criteria for PHLF based on three definitions: 1) ISGLS, 2) Balzan (INR > 1.7 and bilirubin > 2.92 mg/dL) or 3) Mullen (peak bilirubin > 7 mg/dL). We compared the 90-day mortality and major morbidity predicted by each definition. We then used logistic regression to determine the odds of CCI> 40 and 90-day mortality associated with ISGLS grades.ResultsAmong 1646 included patients, 19 (1.1%) met Balzan, 68 (4.1%) met Mullen, and 444 (27.0%) met ISGLS criteria for PHLF. Of the three definitions, the ISGLS criteria best predicted 90-day mortality (AUC = 0.72; sensitivity 69.4%). Patients with ISGLS grades B&C were at increased odds of CCI> 40 (grade B OR 4.0; 95% CI: 2.2-7.2; grade C OR 137.0; 95% CI: 59.2-317.4). Patients with ISGLS grade C were at increased odds of 90-day mortality (OR 113.6; 95% CI: 55.6-232.1). Grade A was not associated with CCI> 40 or 90-day mortality.ConclusionsIn this diverse international cohort of major hepatectomies, ISGLS grade A was not associated with 90-day mortality or high CCI, calling into question the current classification of patients in this group as having clinically significant PHLF.

International Post-Hepatectomy Liver Failure Study Group; Digestive Diseases; Liver Disease; Cancer; Good Health and Well Being; Medical and Health Sciences; Surgery; publication

Open access content. Open access content
CC-BY-NC-SA

application/pdf

CDLER oai:escholarship.org:ark:/13030/qt35s74640
qt35s74640
https://escholarship.org/uc/item/35s74640
https://escholarship.org/
1367391008

UC MASS DIGITIZATION
From OAIster®, provided by the OCLC Cooperative.

edsoai.on1367391008