Predicting risk of post-hepatectomy liver failure in patients undergoing liver resection with controlled low central venous pressure.

Background: Post-hepatectomy liver failure (PHLF), represents a serious complication after liver resection, significantly impacting the long-term outcomes for patients who undergo such surgeries. There exists a strong correlation between intraoperative hemorrhage and transfusion requirements with the development of PHLF. Presently, a combination of hepatic portal occlusion techniques alongside controlled low central venous pressure (CLCVP) methodologies is extensively employed to mitigate intraoperative bleeding. Nonetheless, limited studies have analyzed the risk factors for PHLF under CLCVP.

Aim: To develop and validate a nomogram that predicts the risk factors associated with the development of PHLF patients undergoing liver resection with CLCVP.

Methods: We conducted a retrospective analysis of 285 patients who underwent hepatectomy for the first time and had no history of prior non-index abdominal surgeries, with hepatic inflow occlusion combined with CLCVP from January to December 2019 in Hunan Provincial People's Hospital. Univariate and multivariate regression analyses were used to identify preoperative and intraoperative risk factors for PHLF. Eligible patients were randomly divided into training and validation groups in a 7:3 ratio, and a nomogram prediction model was constructed.

Results: The incidence of PHLF in these patients was 22.46%. Multiple logistic analysis showed that preoperative serum albumin level, causes of liver resection (cancer or others), and cirrhosis were independent preoperative risk factors for PHLF (P < 0.05) and that only post-blocking blood potassium concentration was an independent intraoperative risk factor for PHLF (P < 0.05). Least absolute shrinkage and selection operator regression analysis revealed that preoperative serum albumin level, direct bilirubin level (DBIL), platelet count, causes of liver resection (cancer or others), and cirrhosis were significant predictors of PHLF. The nomogram risk prediction model based on preoperative serum albumin level, DBIL, platelet count, causes of liver resection (cancer or others), cirrhosis and post-blocking blood potassium concentration can better predict the occurrence of PHLF.

Conclusion: For patients undergoing liver resection with CLCVP, serum albumin level, DBIL, platelet count, causes of liver resection (cancer or others), and cirrhosis are independent preoperative risk factors for PHLF.