Liver stiffness measurement predicts high-grade post-hepatectomy liver failure: A prospective cohort study

• Published in: Journal of gastroenterology and hepatology 2017-02, Vol.32 (2), p.506-514
• Main Authors: Chong, Charing Ching-Ning, Wong, Grace Lai-Hung, Chan, Anthony Wing-Hung, Wong, Vincent Wai-Sun, Fong, Anthony Kwong-Wai, Cheung, Yue-Sun, Wong, John, Lee, Kit-Fai, Chan, Stephen L, Lai, Paul Bo-San, Chan, Henry Lik-Yuen
• Format: Article
• Language: English
• Subjects: Aged; Carcinoma, Hepatocellular - pathology; Carcinoma, Hepatocellular - surgery; Cirrhosis; Cohort analysis; Cohort Studies; Elasticity Imaging Techniques - instrumentation; Female; Fibrosis; Health risk assessment; Hepatectomy; Hepatocellular carcinoma; Humans; Liver; Liver - diagnostic imaging; Liver cirrhosis; Liver failure; Liver Failure - diagnostic imaging; Liver Neoplasms - pathology; Liver Neoplasms - surgery; Male; Middle Aged; Multivariate Analysis; Postoperative Complications - diagnostic imaging; Predictive Value of Tests; Prognosis; Prospective Studies; ROC Curve; Severity of Illness Index; Surgery
• ISSN: 0815-9319; 1440-1746
• DOI: 10.1111/jgh.13503

Liver stiffness measurement using transient elastography appears to be an excellent tool for detection of liver fibrosis and cirrhosis with high accuracy. The aim of this study is to evaluate the efficacy of preoperative liver stiffness measurement in predicting post-hepatectomy liver failure. A prospective cohort study of all consecutive patients undergoing hepatectomy for hepatocellular carcinoma from February 2010 to August 2014 was studied. All patients received detailed preoperative assessments including liver stiffness measurement. The primary outcome was post-hepatectomy liver failure according to the International Study Group of Liver Surgery definition. A total of 255 patients were included. Liver stiffness measurement showed significant correlation with grade B or C post-hepatectomy liver failure. (P = 0.003) Using the cutoff at 12 kPa, liver stiffness measurement had a sensitivity of 52.4% and specificity of 73.3% in predication of high-grade (grade B or C) post-hepatectomy liver failure. Liver stiffness measurement > 12 kPa was also an independent prognostic factor for both high-grade post-hepatectomy liver failure and major postoperative complications by multivariate analysis. The diagnostic accuracy was better in patients without right lobe tumor with an area under the receiver operating characteristic of 0.83 compared with an area under the receiver operating characteristic of only 0.62 in patients with right lobe tumor. Liver stiffness measurement using Fibroscan is good to predict high-grade post-hepatectomy liver failure especially in patients without right lobe tumor.