Rahman et al identified risk factors associated with posthepatectomy liver failure (PHLF). These can help to identify a patient who may require more aggressive management. The authors are from St. Jame’s University Hospital in Leeds, England.
Patient selection: hepatectomy
Outcome: post-hepatectomy liver failure (PHLF)
Risk factors for PHLF:
(1) blunted C-reactive protein (CRP) increase following surgery
(2) extent of the hepatic resection, with a reduction in residual liver function. The risk for extended resection was greater than a standard resection which was greater than a minor resection.
Blunted CRP response:
(1) This can be identified on postoperative day 1. A concentration < 32 mg/L was used to identify patients at risk.
(2) Affected patients also tended to show lower CRP levels on postoperative day 3.
where:
• The conversion of CRP units: value in mg/L * 9.524 = nanomoles/L
A blunted CRP response was also associated with:
(1) post-operative sepsis
(2) multi-organ dysfunction systems (MODS)
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