Preoperative Thrombocytopenia May Predict Poor Surgical Outcome after Extended Hepatectomy

Golriz, Mohammad; Ghamarnejad, Omid; Khajeh, Elias; Sabagh, Mohammadsadegh; Mieth, Markus; Hoffmann, Katrin; Ulrich, Alexis; Hackert, Thilo; Weiss, Karl Heinz; Schirmacher, Peter; Büchler, Markus W.; Mehrabi, Arianeb

doi:10.1155/2018/1275720

Cited by 16 publications

(8 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…32 Patients with thrombocytopenia (100 x 10 9 /L or 150 x 10 9 /L) undergoing liver transplantation have increased morbidity and mortality. 33,34 In a cohort of 234 consecutive adult-to-adult living donor liver transplantation recipients, patients with an immediate postoperative low platelet level α≤ 68 X 10 3 /μL had higher rates of early allograft dysfunction (22.6% vs. 7.0%) and severe complications (22.6% vs. 10.9%) compared to those with a platelet level > 68 X 10 3 /μL. 34 One-, three-, and five-year patient survival and graft survival rates of patients with platelet counts < 60 X 10 9 /L on postoperative day 5 are lower than for patients with platelet counts ≥ 60 X 10 9 /L.…”

Section: Predictor Of Hepatic Decompensation After Liver Resection Anmentioning

confidence: 99%

<p>Clinical Implications of Thrombocytopenia for the Cirrhotic Patient</p>

Sigal¹,

Sherman

Jesudian

2020

HMER

View full text Add to dashboard Cite

Thrombocytopenia is a frequent complication in patients with cirrhosis. As many as 84% of patients with cirrhosis have thrombocytopenia, and it is an independent variable indicative of advanced disease and poor prognosis. Although there is great concern that it may aggravate bleeding during surgical procedures, there is limited evidence to inform decisions regarding the treatment of cirrhotic patients with thrombocytopenia undergoing invasive procedures. Finally, there is evidence that platelets play a significant role in liver regeneration. In this report, the clinical implications of thrombocytopenia in cirrhotic patients are reviewed. The utility of platelet counts in the prognosis of cirrhosis and relationship to complications of advanced liver disease, including portal hypertension, esophageal varices, and hepatocellular carcinoma. The impact of low platelet counts on bleeding complications during invasive procedures is outlined. Finally, the role of platelets and potential adverse impact in liver regeneration is reviewed.

show abstract

Section: Predictor Of Hepatic Decompensation After Liver Resection Anmentioning

confidence: 99%

<p>Clinical Implications of Thrombocytopenia for the Cirrhotic Patient</p>

Sigal¹,

Sherman

Jesudian

2020

HMER

View full text Add to dashboard Cite

show abstract

“…These results are, however, contrary to the existing literature evaluating the effect of preoperative platelet count on PHLF. [ 13 – 15 ] For instance, Maithel et al [ 13 ] reported in 231 cirrhotic patients that a platelet count <150 (G/l) constituted a risk factor for PHLF (reconstituted odds ratio: 7.33, 95% CI: 3.04–17.65), [ 8 ] as defined by a peak bilirubin >7 (mg/dl) or ascites. Tomimaru et al [ 14 ] also described in 277 cirrhotic patients that a platelet count <150 (G/l) predicted the occurrence of PHLF (reconstituted odds ratio: 3.81, 95% CI: 1.39–10.48), [ 8 ] as defined by the ISGLS definition.…”

Section: Discussionmentioning

confidence: 99%

“…Tomimaru et al [ 14 ] also described in 277 cirrhotic patients that a platelet count <150 (G/l) predicted the occurrence of PHLF (reconstituted odds ratio: 3.81, 95% CI: 1.39–10.48), [ 8 ] as defined by the ISGLS definition. Further, Golriz et al [ 15 ] recently reported in 231 cirrhotic patients undergoing extended hepatectomy (>4 liver segments) that a preoperative platelet count <150 (G/l) was an independent predictor of PHLF (odds ratio: 4.4, 95% CI: 1.3–15.0), as defined by the ISGLS definition.…”

Section: Discussionmentioning

confidence: 99%

Preoperative platelet count does not predict the occurrence of post-hepatectomy liver failure after partial hepatectomy in a retrospective monocentric cohort study

Hajji¹,

Balaphas²,

Toso³

et al. 2021

Medicine

View full text Add to dashboard Cite

In humans, thrombocytopenic patients have increased incidence of post-hepatectomy liver failure (PHLF), but existing evidence is heterogeneous. Our objective was to determine if preoperative platelet count or antiplatelet drugs were associated with PHLF. Patients who underwent hepatic resection in the University Hospitals of Geneva, Switzerland, from 01.12.2009 to 18.12.2018 were identified. Platelet count at day 0, postoperative days (POD) 1, 3, and 5 were retrieved. Occurrence of PHLF according to the ISGLS definition was determined. Logistic regression was performed to determine if platelet count or antiplatelet drug were predictors for PHLF. Five hundred ninety seven patients were included. Eighty patients (17.8%) had a preoperative platelet count <150 (G/l) and 24 patients (5.3%) had a platelet count <100 (G/l). Thirty five patients (5.9%) were under antiplatelet drug. Platelet count significantly decreased at POD 1 and POD 3 when compared to preoperative platelet count (182 ± 71.61 (G/l) vs 212 ± 85.26 (G/l), P < .0001; 162 ± 68.5 (G/l) vs 212 ± 85.26 (G/l), P < .0001). At POD 5, post-operative platelet count did not significantly differ from its preoperative value. Forty three patients (11.2%) suffered from PHLF. Their platelet count was not significantly different than patients without PHLF (211 ± 89.7 (G/l) vs 211 ± 83.5 (G/l), P = .671). One patient with PHLF had a platelet count <100 (G/l) and 5 had a count <150 (G/l). Univariate logistic regression did not identify preoperative thrombocytopenia (<100 (G/l) or <150 (G/l)), postoperative thrombocytopenia, or the presence of antiagregant drug, as predictors of PHLF. We did not identify preoperative or postoperative thrombocytopenia as predictor of PHLF in a cohort of 597 patients.

show abstract

“…In recent years, improved hepatic resection techniques and expanding indications have increased the use of extensive liver resection, leading to a higher risk of PHLF. Single-center studies report PHLF risk ranging between 25.8% and 35.3%, and the severe PHLF ranged between 11.3% and 28% [20][21][22][23]. Due to the large tumor diameters and major vascular invasion, approximately 62-80% of patients with huge HCC patients undergo major or extensive liver resection leading to morbidity and mortality rates ranging between 10.9-43.6% and 4.2-18.1% [24][25][26][27], respectively.…”

Section: Discussionmentioning

confidence: 99%

CT Radiomics Nomogram for the Preoperative Prediction of Severe Post-Hepatectomy Liver Failure in Patients with Huge (≥10 cm) Hepatocellular Carcinoma

Fei

Liang

Yang

et al. 2021

Preprint

View full text Add to dashboard Cite

Background To establish a radiomics-based nomogram for predicting severe (grade B or C) post-hepatectomy liver failure (PHLF) in patients with huge (≥10 cm) hepatocellular carcinoma (HCC).Methods 186 patients with huge HCC (n = 131 for training dataset and n = 55 for test dataset) who underwent curative hepatic resection were included. The least absolute shrinkage and selection operator approach was applied to develop the radiomics signature for grade B or C PHLF prediction in the training dataset. A multivariable logistic regression model was used by incorporating radiomics signature and other clinical predictors to establish a radiomics nomogram. A decision tree was created to stratify the risk for severe PHLF.Results The radiomics signature consisting of nine features predicted severe PHLF with an AUC of 0.766 and 0.745 in the training and test datasets, respectively. The radiomics nomogram was generated by integrating the radiomics signature, the extent of resection and model for end-stage liver disease (MELD) score. The nomogram exhibited satisfactory discrimination and calibration, with an AUC of 0.842 and 0.863 in the training and test datasets, respectively. Decision tree split patients into 3 risk classes: low-risk patients with radiomics score < -0.247 and MELD score < 10 or，radiomics score ≥ -0.247 and underwent partial resections; intermediate-risk patients with radiomics score < -0.247 but MELD score ≥10; high-risk patients with radiomics score ≥ -0.247 and underwent extended resections.Conclusions The radiomics nomogram was able to predict severe PHLF in huge HCC patients. Decision tree may be useful in surgical decision-making for huge HCC hepatectomy.

show abstract

Preoperative Thrombocytopenia May Predict Poor Surgical Outcome after Extended Hepatectomy

Cited by 16 publications

References 34 publications

<p>Clinical Implications of Thrombocytopenia for the Cirrhotic Patient</p>

<p>Clinical Implications of Thrombocytopenia for the Cirrhotic Patient</p>

Preoperative platelet count does not predict the occurrence of post-hepatectomy liver failure after partial hepatectomy in a retrospective monocentric cohort study

CT Radiomics Nomogram for the Preoperative Prediction of Severe Post-Hepatectomy Liver Failure in Patients with Huge (≥10 cm) Hepatocellular Carcinoma

Contact Info

Product

Resources

About