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Use of liver stiffness measurement for liver resection surgery: correlation with indocyanine green clearance testing and post-operative outcome.

Fung J, Poon RT, Yu WC, Chan SC, Chan AC, Chok KS, Cheung TT, Seto WK, Lo CM, Lai CL, Yuen MF - PLoS ONE (2013)

Bottom Line: There was significant correlation between ICG R15 and LSM.For patients with ICG R15≥10% compared to those <10%, there was significantly higher LSM (12.0 vs 7.6 kPa respectively, p = 0.015).The operative time was a significant independent factor associated with post-operative complications and peak INR.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, The University of Hong Kong, Hong Kong, China.

ABSTRACT

Background: Liver stiffness measurement (LSM) using transient elastography has recently become available for the assessment of liver fibrosis. Whether LSM can predict the functional liver reserve in patients undergoing liver resection is not certain.

Aim: To correlate liver stiffness measurement (LSM) with indocyanine green (ICG) clearance test and liver biochemistry, and to determine its usefulness in predicting postoperative outcomes in patients undergoing liver resection.

Patients and methods: Transient elastography and ICG clearance test were performed pre-operatively in 44 patients with hepatocellular carcinoma. The LSM and ICG retention rate at 15 minutes (R15) were correlated with pre-operative factors and post-operative outcomes.

Results: There was significant correlation between ICG R15 and LSM. In patients with LSM ≥11 kPa vs <11 kPa, there was significantly higher ICG R15 (17.1% vs 10.0% respectively, p = 0.025). For patients with ICG R15≥10% compared to those <10%, there was significantly higher LSM (12.0 vs 7.6 kPa respectively, p = 0.015). Twenty-eight patients proceeded to resection. There was a significant correlation between LSM and the peak INR after liver resection (r = 0.426, p = 0.024). There was a significant correlation between ICG R15 and the post-operative peak AST level (r = -0.414, p = 0.029) and peak ALT level (r = -0.568, p = 0.002). The operative time was a significant independent factor associated with post-operative complications and peak INR.

Conclusion: LSM correlated well with ICG R15 in patients undergoing liver resection, and predicted early post-operative complications. Addition of LSM to ICG R15 testing may provide better prognostic information for patients undergoing resection.

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Comparison between LSM and ICG R15.
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pone-0072306-g001: Comparison between LSM and ICG R15.

Mentions: A total of 68 patients were enrolled during the recruitment period in the current study. Twenty four were excluded from the final analysis due to suboptimal (22 patients had high IQR/LSM ratio) or invalid LSM (2 patients had less than 10 valid measurements). Forty-four patients were included in the final analysis. Thirty six (82%) were male. The median age was 59 years (range, 46–75). The basic patient demographics and laboratory data are summarized in table 1. The correlation between ICG clearance and LSM with age and other routine laboratory parameters are summarized in table 2. There were significant correlations between ICG R15 and LSM, bilirubin, albumin, international normalized ratio (INR), platelet levels, and MELD scores, and between LSM and AST, albumin, INR, and MELD scores. A previous study of CHB patients identified a LSM cut-off value of 11 kPa for the presence of cirrhosis [19]. In our patients with LSM ≥11 kPa vs <11 kPa, there was significantly higher ICG R15 (17.1% vs 10.0% respectively, p = 0.025), lower albumin (38 vs 45 g/L respectively, p<0.001), higher INR (1.1 vs 1.0 respectively, p<0.001), and lower platelet counts (131 vs 170×109/L respectively, p = 0.043). The normal ICG R15 is <10% [18]. For patients with ICG R15≥10% compared to those <10%, there was significantly higher LSM (12.0 vs 7.6 kPa respectively, p = 0.015), higher bilirubin (12 vs 8 umol/L respectively, p = 0.039), lower albumin (41 vs 46 g/L respectively, p<0.001), higher INR (1.1 vs 1.0 respectively, p<0.001), and lower platelet counts (132 vs 178×109/L respectively, p = 0.027). The comparison between LSM and ICG R15 is shown in figure 1. Using multivariate analysis, only albumin remained a significant factor associated with both ICG R15 and LSM (p = 0.011 and p = 0.007 respectively).


Use of liver stiffness measurement for liver resection surgery: correlation with indocyanine green clearance testing and post-operative outcome.

Fung J, Poon RT, Yu WC, Chan SC, Chan AC, Chok KS, Cheung TT, Seto WK, Lo CM, Lai CL, Yuen MF - PLoS ONE (2013)

Comparison between LSM and ICG R15.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3756082&req=5

pone-0072306-g001: Comparison between LSM and ICG R15.
Mentions: A total of 68 patients were enrolled during the recruitment period in the current study. Twenty four were excluded from the final analysis due to suboptimal (22 patients had high IQR/LSM ratio) or invalid LSM (2 patients had less than 10 valid measurements). Forty-four patients were included in the final analysis. Thirty six (82%) were male. The median age was 59 years (range, 46–75). The basic patient demographics and laboratory data are summarized in table 1. The correlation between ICG clearance and LSM with age and other routine laboratory parameters are summarized in table 2. There were significant correlations between ICG R15 and LSM, bilirubin, albumin, international normalized ratio (INR), platelet levels, and MELD scores, and between LSM and AST, albumin, INR, and MELD scores. A previous study of CHB patients identified a LSM cut-off value of 11 kPa for the presence of cirrhosis [19]. In our patients with LSM ≥11 kPa vs <11 kPa, there was significantly higher ICG R15 (17.1% vs 10.0% respectively, p = 0.025), lower albumin (38 vs 45 g/L respectively, p<0.001), higher INR (1.1 vs 1.0 respectively, p<0.001), and lower platelet counts (131 vs 170×109/L respectively, p = 0.043). The normal ICG R15 is <10% [18]. For patients with ICG R15≥10% compared to those <10%, there was significantly higher LSM (12.0 vs 7.6 kPa respectively, p = 0.015), higher bilirubin (12 vs 8 umol/L respectively, p = 0.039), lower albumin (41 vs 46 g/L respectively, p<0.001), higher INR (1.1 vs 1.0 respectively, p<0.001), and lower platelet counts (132 vs 178×109/L respectively, p = 0.027). The comparison between LSM and ICG R15 is shown in figure 1. Using multivariate analysis, only albumin remained a significant factor associated with both ICG R15 and LSM (p = 0.011 and p = 0.007 respectively).

Bottom Line: There was significant correlation between ICG R15 and LSM.For patients with ICG R15≥10% compared to those <10%, there was significantly higher LSM (12.0 vs 7.6 kPa respectively, p = 0.015).The operative time was a significant independent factor associated with post-operative complications and peak INR.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, The University of Hong Kong, Hong Kong, China.

ABSTRACT

Background: Liver stiffness measurement (LSM) using transient elastography has recently become available for the assessment of liver fibrosis. Whether LSM can predict the functional liver reserve in patients undergoing liver resection is not certain.

Aim: To correlate liver stiffness measurement (LSM) with indocyanine green (ICG) clearance test and liver biochemistry, and to determine its usefulness in predicting postoperative outcomes in patients undergoing liver resection.

Patients and methods: Transient elastography and ICG clearance test were performed pre-operatively in 44 patients with hepatocellular carcinoma. The LSM and ICG retention rate at 15 minutes (R15) were correlated with pre-operative factors and post-operative outcomes.

Results: There was significant correlation between ICG R15 and LSM. In patients with LSM ≥11 kPa vs <11 kPa, there was significantly higher ICG R15 (17.1% vs 10.0% respectively, p = 0.025). For patients with ICG R15≥10% compared to those <10%, there was significantly higher LSM (12.0 vs 7.6 kPa respectively, p = 0.015). Twenty-eight patients proceeded to resection. There was a significant correlation between LSM and the peak INR after liver resection (r = 0.426, p = 0.024). There was a significant correlation between ICG R15 and the post-operative peak AST level (r = -0.414, p = 0.029) and peak ALT level (r = -0.568, p = 0.002). The operative time was a significant independent factor associated with post-operative complications and peak INR.

Conclusion: LSM correlated well with ICG R15 in patients undergoing liver resection, and predicted early post-operative complications. Addition of LSM to ICG R15 testing may provide better prognostic information for patients undergoing resection.

Show MeSH
Related in: MedlinePlus