The risk of mortality within 30 days following nonhepatic surgery can be estimated in adult patients with chronic hepatic failure based on review of clinical and laboratory findings.
Patient population:
(1) 40 adult patients with chronic liver failure undergoing nonhepatic surgery requiring general anesthesia
(2) 11 patients (28%) died within 30 days of surgery
Operative procedures included:
(1) biliary tract procedures
(2) colon resection
(3) bleeding gastric ulcers
(4) lysis of adhesions for small bowel obstruction
(5) coronary artery bypass procedures
(6) orthopedic procedures
(7) variety of neurosurgical, plastic, urologic and gynecologic procedures
Variables independently predicting mortality by multivariate analysis:
(1) encephalopathy (35.5 fold increase in mortality)
(2) prothrombin time expressed as the international normalized ratio (INR) > 1.6 (10.6 fold increase in mortality)
Additional variables significantly associated with nonsurvival:
(1) congestive heart failure
(2) the need for emergency surgery
(3) infection
(4) hyperbilirubinemia (level not given; will use > 2.5 mg/dL)
(5) hypoalbuminemia (level not given; will use < 2.4 g/dL)
(6) elevated creatinine levels (> 2 mg/dL)
Laboratory Values
|
|
Survivors
|
Nonsurvivors
|
|
albumin
|
3.0 +/- 0.6 g/dL
|
2.2 +/- 0.5 g/dL
|
|
bilirubin
|
1.4 +/- 1.1 g/dL
|
7.2 +/- 8.9 mg/dL
|
|
creatinine
|
1.0 +/- 0.6 mg/dL
|
1.7 +/- 0.5 mg/dL
|
Normalranges for adults (Tietz, 1995)
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Age
|
Adults up to 60 Years
|
60-90 Years
|
|
albumin
|
3.4-4.8 g/dL
|
3.2-4.6 g/dL
|
|
bilirubin
|
0.3-1.2 mg/dL
|
0.2-1.1 mg/dL
|
