Indocyanine green retention is a potential prognostic indicator after splenectomy and pericardial devascularization for cirrhotic patients

• Published in: Hepatobiliary & pancreatic diseases international Vol. 15; no. 4; pp. 386 - 390
• Main Authors: Zhang, Yuan-Biao, Lu, Yi, Wu, Wei-Ding, Zhang, Cheng-Wu, Shen, Guo-Liang, Hong, De-Fei
• Format: Journal Article
• Language: English
• Published: Singapore Elsevier B.V 15.08.2016
• Subjects: Adult; Area Under Curve; Chi-Square Distribution; Endocrinology & Metabolism; Female; Fluorescent Dyes - administration & dosage; Gastroenterology and Hepatology; Gastrointestinal Hemorrhage - diagnosis; Gastrointestinal Hemorrhage - etiology; Gastrointestinal Hemorrhage - surgery; Hemostatic Techniques - adverse effects; Humans; Hypersplenism - diagnosis; Hypersplenism - etiology; Hypersplenism - surgery; Hypertension, Portal - diagnosis; Hypertension, Portal - etiology; indocyanine green; Indocyanine Green - administration & dosage; liver cirrhosis; Liver Cirrhosis - complications; Liver Cirrhosis - diagnosis; liver function test; Liver Function Tests; Male; Middle Aged; Multivariate Analysis; pericardial devascularization; Pericardium - surgery; Postoperative Complications - etiology; Predictive Value of Tests; Reproducibility of Results; Retrospective Studies; Risk Factors; ROC Curve; splenectomy; Splenectomy - adverse effects; Treatment Outcome; 上消化道出血; 功能评估; 吲哚; 患者; 肝硬化; 脾; 血管; 预后; indocyanine green; liver function test; liver cirrhosis; splenectomy; pericardial devascularization
• ISSN: 1499-3872
• DOI: 10.1016/S1499-3872(16)60114-5

BACKGROUND：Splenectomy and pericardial devascularization（SPD）is an effective treatment of upper gastrointestinal bleeding and hypersplenism in cirrhotic patients with portal hypertension.Indocyanine green retention at 15 minutes（ICGR15）was reported to offer better sensitivity and specificity than the Child-Pugh classification in hepatectomy,but few reports describe ICGR15 in SPD.The present study was to evaluate the prognostic value of ICGR15 for cirrhotic patients with portal hypertension who underwent SPD.METHODS：From January 2012 to January 2015,43 patients with portal hypertension and hypersplenism caused by liver cirrhosis were admitted in our center and received SPD.The ICGR15,Child-Pugh classification,model for end-stage liver disease（MELD）score,and perioperative characteristics were analyzed retrospectively.RESULTS：Preoperative liver function assessment revealed that 34 patients were Child-Pugh class A with ICGR15 of13.6%-43.0%and MELD score of 7-20;8 patients were class B with ICGR15 of 22.8%-40.7%and MELD score of 7-17;1patient was class C with ICGR15 of 39.7%and MELD score of 22.The optimal ICGR15 threshold for liver function compensation was 31.2%,which offered a sensitivity of 68.4%and a specificity of 70.8%.Univariate analysis showed preoperative ICGR15,MELD score,surgical procedure,intraoperative blood loss,and autologous blood transfusion were significantly different between postoperative liver function compensated and decompensated groups.Multivariate regression analysis revealed that ICGR15 was an independent risk factor of postoperative liver function recovery（P=0.020）.CONCLUSIONS：ICGR15 has outperformed the Child-Pugh classification for assessing liver function in cirrhotic patients with portal hypertension.ICGR15 may be a suitable prognostic indicator for cirrhotic patients after SPD.