The “50-50 Criteria” on Postoperative Day 5: An Accurate Predictor of Liver Failure and Death After Hepatectomy

Objective:To standardize the definition of postoperative liver failure (PLF) for prediction of early mortality after hepatectomy. Summary Background Data:The definition of PLF is not standardized, making the comparison of innovations in surgical techniques and the timely use of specific therapeutic interventions complex. Methods:Between 1998 and 2002, 775 elective liver resections, including 69% for malignancies and 60% major resections, were included in a prospective database. The nontumorous liver was abnormal in 43% with steatosis >30% in 14%, noncirrhotic fibrosis in 43%, and cirrhosis in 12%. The impact of prothrombin time (PT) <50% and serum bilirubin (SB) >50 &mgr;mol/L on postoperative days (POD) 1, 3, 5, and 7 was analyzed. Results:The lowest PT level was observed on postoperative day (POD) 1, while the peak of SB was observed on POD 3. These 2 variables tended to return to preoperative values by POD 5. The median interval between hepatectomy and postoperative death was 15 days (range, 5–39 days). Postoperative mortality significantly increased in patients with PT <50% and SB >50 &mgr;ml/L. The conjunction of PT <50% and SB >50 &mgr;mol/L on POD 5 was a strong predictive factor of mortality. In patients with significant morbidity, this “50-50 criteria” was met 3 to 8 days before clinical evidence of complications. Conclusions:The association of PT <50% and SB >50 &mgr;ml/L on POD 5 (the 50-50 criteria) was a simple, early, and accurate predictor of more than 50% mortality rate after hepatectomy. This criteria could be identified early enough, before clinical evidence of complications, for specific interventions to be applied in due time.