Skip to main content
SpringerLink
Log in

Assessment of liver function by prognostic score after relief of obstructive jaundice

  • Topics
  • Published:
Journal of Hepato-Biliary-Pancreatic Surgery

Abstract

To evaluate liver function reserve after relief of obstructive jaundice, we investigated the correlation between outcome after hepatectomy and 16 perioperative clinical factors in 13 patients with hilar bile duct carcinoma. The patients were classified into two groups according to the presence or absence of postoperative hepatic failure, defined as serum total bilirubin level exceeding 10mg/dl. A prognostic score formula was then created retrospectively. Total bilirubin, plasma retention rate of indocyanine green at 15 min (ICGR15), bilirubin decrease rate (b value), and duration of operation showed significant inter-group relationships on univariate analysis. By stepwise logistic regression we proposed the following discriminant formula: Prognostic score=−16.155+2.223×(ICGR15) +1.492×(liver resection ratio) +0.807×(b value ×103) With this formula, scores for patients without hepatic failure were 33 or less while those for hepatic failure patients were 68 or more, showing a clear distinction between the groups. Preoperative portal embolization (PE) decreased the mean prognostic score from 101.2 to 81.2, but 3 of 4 patients survived the operation without hepatic failure despite their high prognostic scores. This prognostic score is useful for predicting postoperative hepatic failure in patients with obstructive jaundice. However, further prospective studies are required to confirm the reliability of this formula, and some other mode of prognostic assessment is needed for patients who have preoperative PE.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Takada T (1976) Direct percutaneous transhepatic cholangial drainage under fluoroscopic control (in Japanese with English abstract). Nippon Syhokakigeka Gakkai Zasshi (Jpn J Gastroenterol Surg) 9:791–803

    Google Scholar 

  2. Takada T, Shikata J, Hanyu F (1986) Re-evaluation of preoperative percutaneous transhepatic cholangiodrainage for obstructive jaundice (in Japanese with English abstract). Nippon Geka Gakkai Zasshi (J Jpn Surg Society) 87:1083–1086

    Google Scholar 

  3. Shimada H, Matsuba A, Nimoto S, Fujita H, Nakagawara G (1989) Liver failure after hepatic resection (in Japanese). Nippon Geka Gakkai Zasshi (J Jpn Surg Society) 90:566–572

    PubMed  CAS  Google Scholar 

  4. Yamamoto M, Inoue S, Iimura Y, Nagahori K, Fujii H, Aoyama H, Oomori Y, Matsumoto Y, Sugihara K (1987) Multiple organ failure associated with postoperative non-obstructive jaundice (in Japanese with English abstract). Nippon Syhokakigeka Gakkai Zasshi (Jpn J Gastroenterol Surg) 20:2455–2459

    Google Scholar 

  5. Shimizu T, Yoshida K (1989) Evaluation of serum bilirubin decreasing rate “b” (in Japanese). Tan to Sui (J Bil Pancr) 10:583–590

    Google Scholar 

  6. Shimizu T, Sato O, Tsukada K (1996) Re-estimation of the bilirubin decrease rate “b” (b value) in patients with obstructive jaundice. J Hep Bil Pancr Surg 3:12–16

    Article  Google Scholar 

  7. Yamanaka N, Okamoto E, Kuwata K, Tanaka N (1984) A multiple regression equation for prediction of posthepatectomy liver failure. Ann Surg 200:658–663

    PubMed  CAS  Google Scholar 

  8. Nimura Y, Hayakawa N, Kamiya J, Maeda S, Kondo S, Yasui A, Shionoya S (1991) Hepatopancreatoduodenectomy for advanced carcinoma of the biliary tract. Hepatogastroenterology 38:170–175

    PubMed  CAS  Google Scholar 

  9. Iwatsuki A (1976) Studies of liver mitochondrial function during and after experimental biliary obstruction (in Japanese with English abstract). Nippon Syhokakigeka Gakkai Zasshi (Jpn J Gastroenterol Surg) 9:622–630

    Google Scholar 

  10. Kawasaki S, Sugiyama Y, Iga T, Hanano M, Sanjo K, Beppu T, Idezuki Y (1985) Pharmacokinetic study on the hepatic uptake of indocyanine green in cirrhotic patients. Am J Gastroenterol 80:801–806

    PubMed  CAS  Google Scholar 

  11. Kawarada Y, Higashiguchi T, Konno T, Noguchi T (1989) ICGRmax (in Japanese). Tan to Sui (J Bil Pancr) 10:599–605

    Google Scholar 

  12. Izawa K, Sasaki M, Tomioka T, Kanamatsu T (1994) Evaluation of ICG Bmax in hepatectomized patients undergoing biliary decompression for obstructive jaundice (in Japanese with English abstract). Tando (J Jpn Bil Association) 8:197–203

    Google Scholar 

  13. Ozawa K (1983) Biological significance of mitochondrial redox potential in shock and multiple organ failure: Redox theory. Proc Clin Biol Res 111:39–66

    CAS  Google Scholar 

  14. Kamiyama Y, Takeda H, Ohshita M, Nambu H, Yamaoka Y, Yamamoto M, Kimura K, Ozawa K, Honjo I (1977) Hepatic metabolic changes following energy deprivation by ammonia in patients and rabbits with jaundice. Surg Gynecol Obstet 145:33–40

    PubMed  CAS  Google Scholar 

  15. Koyama K, Takagi Y, Ito K, Sato T (1981) Experimental and clinical studies on the effect of biliary drainage in obstructive jaundice. Am J Surg 142:293–299

    Article  PubMed  CAS  Google Scholar 

  16. Tsubono T, Tsukada K, Muto T (1993) The redox tolerance test as a measure of hepatic function in patients with obstructive jaundice. Int Hepatol Commun 1:48–52

    Article  Google Scholar 

  17. Mori K, Ozawa K, Yamamoto Y, Maki A, Shimahara Y, Kobayashi N, Yamaoka Y, Kumada K (1990) Response of hepatic mitochondrial redox state to oral glucose load. Ann Surg 211:438–446

    PubMed  CAS  Google Scholar 

  18. Kimura K, Ukikusa M, Ozawa K, Tobe T (1978) Changes in mitochondrial redox state following an oral glucose load. Acta Diab Lat 15:283–286

    CAS  Google Scholar 

  19. Tanaka J, Ozawa K, Tobe T (1979) Significance of blood ketone body ratio as an indicator of hepatic cellular energy status in jaundiced rabbits. Gastroenterology 76:691–696

    PubMed  CAS  Google Scholar 

  20. Schaffner F, Popper H (1985) Classification and mechanism of cholestasis. In: Wright R, Alberti KGMM, Karran S, Millward-Sadler GDT (eds) Liver and biliary disease: Pathophysiology, diagnosis, management, 2nd edn. Saunders, London, Ch 15, pp 359–386

    Google Scholar 

  21. Blumgart LH (1978) Biliary tract obstruction—new approaches to old problems. Am J Surg 135:19–31

    Article  PubMed  CAS  Google Scholar 

  22. Kato S, Nagino I, Nimura Y, Wakabayashi T (1994) Hepatic recovery after biliary drainage in experimental obstructive jaundice complicated by biliary infection. Hepatogastroenterology 41:217–221

    PubMed  CAS  Google Scholar 

  23. Nagano I, Sato S, Nimura Y, Wakabayashi T (1994) Hepatic mitochondrial changes in experimental obstructive jaundice complicated by biliary infection. Hepatogastroenterology 41:432–437

    PubMed  CAS  Google Scholar 

  24. Shimada H, Fukushima Y, Nimoto S, Matsuba A, Seki H, Isobe Y, Kinoshita H, Miwa K, Nakagawara G, Kobayashi M, Tsuchiya S (1989) Multiple organ failure caused by severe cholangitis (in Japanese). Hukubukyukyushinryo no Shinpo (Prog Abd Med) 4:49–53

    Google Scholar 

  25. Komine N, Hatsuse K, Saito S, Shono S, Aoki H, Idei T, Murayama M, Sakai Y, Kakihara M, Tamakuma S (1993) Relationship between reduction rate of serum bilirubin level, factors in prolonged jaundice and serum type IV collagen (7S domain) levels in patients with obstructive jaundice (in Japanese with English abstract). Nippon Syhokakigeka Gakkai Zasshi (Jpn J Gastroenterol Surg) 26:2302–2307

    Google Scholar 

  26. Nagino M, Nimura Y, Hayakawa N, Komiya J, Kondo S, Sasaki R, Hamajima N (1993) Logistic regression and discriminant analyses of hepatic failure after liver resection for carcinoma of the biliary tract. World J Surg 17:250–255

    Article  PubMed  CAS  Google Scholar 

  27. Makuuchi M, Bao Le Thai, Takayasu K, Takayama T, Kosuge T, Gunven P, Yamazaki S, Hasegawa H, Ozaki H (1990) Preoperative portal embolization to increase safety of major hepatectomy for hilar bile duct carcinoma: A preliminary report. Surgery 107:521–527

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Second Department of Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, 236, Yokohama, Japan

    Tetsuya Takahashi, Itaru Endo, Katsumi Go, Hitoshi Sekido, Shinji Togo, Akira Nakano & Hiroshi Shimada

Authors
  1. Tetsuya Takahashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Itaru Endo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Katsumi Go
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hitoshi Sekido
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Shinji Togo
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Akira Nakano
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Hiroshi Shimada
    View author publications

    You can also search for this author in PubMed Google Scholar

About this article

Cite this article

Takahashi, T., Endo, I., Go, K. et al. Assessment of liver function by prognostic score after relief of obstructive jaundice. J Hep Bil Pancr Surg 4, 269–275 (1997). https://doi.org/10.1007/BF02489024

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02489024

Key words

Search

Navigation