Relevance of the ISGLS Definition of Posthepatectomy Liver Failure in Early Prediction of Poor Outcome After Liver Resection

Abstract

In Brief Objective: To assess the relevance of the International Study Group of Liver Surgery (ISGLS) definition of posthepatectomy liver failure compared with 2 well-established criteria, 50–50 and PeakBili >7, as early predictors of posthepatectomy outcome. Background: There is limited data on the postoperative use of ISGLS definition of posthepatectomy liver failure as early predictor of outcome. Methods: Between 2007 and 2012, a total of 680 hepatectomies were analyzed from a prospective database. The value of each definition for prediction of 3-month major complications (Clavien III–V) and mortality was assessed either within 10 days of surgery or on postoperative day 5. Results: Three-month major morbidity and mortality rates were 16.5% and 4.4%, respectively. Within 10 days, 79 patients fulfilled ISGLS definition compared with 24 for 50–50 and 44 for PeakBili >7 criteria. Sensitivities of ISGLS definition and 50–50 and PeakBili >7 criteria for prediction of major morbidity and mortality were 35.8, 17.4, 24.8% and 56.7, 36.7, 56.7%, respectively. Patients with no positive score had a risk of death or major complication below 5% and 15%, respectively. In patients with a positive score, the ISGLS definition was the least relevant to predict major complications and mortality (positive predictive values of 49.4% and 21.8% vs 79.2% and 47.8% for 50–50 and 61.4% and 40.5% for PeakBili >7 criteria). The relative risk of death was 6.9 (95% confidence interval, 3.1–15.4) if the ISGLS definition was evaluated on postoperative day 5 versus 21.1 (95% confidence interval, 7.7–57.7) for 50–50 and 21.7 (95% confidence interval, 7.4–63.3) for PeakBili >7 criteria. Conclusions: ISGLS definition was less discriminatory than 50–50 and PeakBili >7 criteria in identifying patients at risk of posthepatectomy major complications or death. This study evaluated the International Study Group of Liver Surgery definition of posthepatectomy liver failure as early predictor of poor outcome and compared it with 50–50 and PeakBili > 7 criteria. Results showed ISGLS definition as less discriminatory than 50–50 and PeakBili > 7 criteria in identifying patients at risk of posthepatectomy major complications or death.