Patient selection: elective hepatectomy
Outcome perioperative red blood cell transfusion
Parameters for nomogram:
(1) number of segments resected
(2) diagnosis
(3) resection of extrahepatic organ at the surgery
(4) preoperative hemoglobin (in g/dL) from 7 to 20
(5) preoperative platelet count per µL
|
Parameter
|
Finding
|
Points
|
|
number of segments resected
|
1
|
6.9
|
|
|
2
|
13.8
|
|
|
3
|
20.4
|
|
|
4
|
31.7
|
|
|
5
|
42.8
|
|
|
6
|
54.2
|
|
diagnosis
|
primary
|
7.8
|
|
|
metastatic
|
0
|
|
extrahepatic organ resection
|
no
|
0
|
|
|
yes
|
12
|
points for hemoglobin =
= 106.46 - (5.32 * (hemoglobin))
|
Platelet Count
|
Points
|
|
39,000 to 251,188
(LOG10 1.6 to 2.4)
|
(143.3 * (LOG^2)) - (698.2 * (LOG)) + 850.3
|
|
251,188 to 361,227
|
0
|
|
361,227 to 1,258,925
(LOG10 2.5 to 3.1)
|
(143.2 * (LOG^2)) - (696 * (LOG)) + 847.5
|
where:
LOG10(X) = LOG10((platelet count) / 1000)
total score for the nomogram =
= SUM(points for all 5 parameters)
|
Points
|
Percent Transfused
|
|
< 28
|
< 10%
|
|
28 to 74.9
|
(0.00947 * ((points)^2)) - (0.0755 * (points)) + 4.95
|
|
75 to 121
|
(-0.009175 * ((points)^2)) + (2.657 * (points)) - 97.17
|
|
> 121
|
> 90%
|
Equation from page 917
X =
= 41.69 - (0.25 * (hemoglobin)) + (0.37 if tumor primary else 0) + (0.56 if extrahepatic resection else 0) - (33.01 * LOG10((platelet count)/1000)) + (6.78 * (LOG10((platelet count)/1000))^2) + (0.32 * (number of segments resected)) + ((0.21 * ((number of segments resected) - 3)) if more than 3 segments resected else 0)
probability of blood transfusion =
= 1 / (1 + EXP((-1) * X))
