Child-Pugh Parameters and Platelet Count as an Alternative to ICG Test for Assessing Liver Function for Major Hepatectomy

Kin-Pan Au, See-Ching Chan, Kenneth Siu-Ho Chok, Albert Chi-Yan Chan, Tan-To Cheung, Kelvin Kwok-Chai Ng, Chung-Mau Lo, Kin-Pan Au, See-Ching Chan, Kenneth Siu-Ho Chok, Albert Chi-Yan Chan, Tan-To Cheung, Kelvin Kwok-Chai Ng, Chung-Mau Lo

Abstract

Objective: To study the correlations and discrepancies between Child-Pugh system and indocyanine green (ICG) clearance test in assessing liver function reserve and explore the possibility of combining two systems to gain an overall liver function assessment.

Design: Retrospective analysis of 2832 hepatocellular carcinoma (HCC) patients graded as Child-Pugh A and Child-Pugh B with ICG clearance test being performed was conducted.

Results: ICG retention rate at 15 minutes (ICG15) correlates with Child-Pugh score, however, with a large variance. Platelet count improves the correlation between Child-Pugh score and ICG15. ICG15 can be estimated using the following regression formula: estimated ICG15 (eICG15) = 45.1 + 0.435 × bilirubin - 0.917 × albumin + 0.491 × prothrombin time - 0.0283 × platelet (R2 = 0.455). Patients with eICG15 >20.0% who underwent major hepatectomy had a tendency towards more posthepatectomy liver failure (4.1% versus 8.0%, p = 0.09) and higher in-hospital mortality (3.7% versus 8.0%, p = 0.052). They also had shorter median overall survival (5.10 ± 0.553 versus 3.01 ± 0.878 years, p = 0.015) and disease-free survival (1.37 ± 0.215 versus 0.707 ± 0.183 years, p = 0.018).

Conclusion: eICG15 can be predicted from Child-Pugh parameters and platelet count. eICG15 correlates with in-hospital mortality after major hepatectomy and predicts long-term survival.

Figures

Figure 1
Figure 1
Flow diagram of this study.
Figure 2
Figure 2
Correlation between ICG15 and Child-Pugh score. A linear relationship is expressed by ICG15 = −27.4 + 8.21 × Child-Pugh score (R2 = 0.264). Error bars: ±1 SD.
Figure 3
Figure 3
Correlation between ICG15 and Child-Pugh score stratified by platelet count. Error bars: ±1 SD.
Figure 4
Figure 4
Relation between mean eICG15 and ICG15.
Figure 5
Figure 5
Mean error of eICG15 against ICG15.
Figure 6
Figure 6
Receiver operating characteristic curve determining cut-off point of eICG15 to predict ICG15 ≤14%. Area under curve = 0.804. Diagonal segments are produced by ties.
Figure 7
Figure 7
Distribution of patients with ICG15 >14% by eICG15.
Figure 8
Figure 8
Overall survival after major hepatectomy, stratified by eICG15. Median overall survival 5.10 ± 0.553 versus 3.01 ± 0.878 years, p = 0.015.
Figure 9
Figure 9
Disease-free survival after major hepatectomy, stratified by eICG15. Median disease-free survival 1.37 ± 0.215 versus 0.707 ± 0.183 years, p = 0.018.
Figure 10
Figure 10
Algorithm for interpreting eICG15.

References

    1. Pugh R. N. H. Pugh's grading in the classification of liver decompensation. Gut. 1992;33(11):p. 1583. doi: 10.1136/gut.33.11.1583.
    1. Bader K. F. Thoracic Ileopexy for Portal Hypertension. Archives of Surgery. 1964;89(1):p. 228. doi: 10.1001/archsurg.1964.01320010230027.
    1. Pugh R. N. H., Murray Lyon I. M., Dawson J. L. Transection of the oesophagus for bleeding oesophageal varices. The British Journal of Surgery. 1973;60(8):646–649. doi: 10.1002/bjs.1800600817.
    1. Llovet J. M., Bruix J., Gores G. J. Surgical resection versus transplantation for early hepatocellular carcinoma: Clues for the best strategy. Hepatology. 2000;31(4):1019–1021. doi: 10.1053/he.2000.6959.
    1. Christensen E., Schlichting P., Fauerholdt L., et al. Prognostic value of child‐turcotte criteria in medically treated cirrhosis. Hepatology. 1984;4(3):430–435. doi: 10.1002/hep.1840040313.
    1. Llovet J. M., Brú C., Bruix J. Prognosis of hepatocellular carcinoma: the BCLC staging classification. Seminars in Liver Disease. 1999;19(3):329–338. doi: 10.1055/s-2007-1007122.
    1. Llovet J. M., Fuster J., Bruix J. The Barcelona approach: Diagnosis, staging, and treatment of hepatocellular carcinoma. Liver Transplantation. 2004;10(2):S115–S120. doi: 10.1002/lt.20034.
    1. Lau H., Man K., Fan S.-T., Yu W.-C., Lo C.-M., Wong J. Evaluation of preoperative hepatic function in patients with hepatocellular carcinoma undergoing hepatectomy. British Journal of Surgery. 1997;84(9):1255–1259. doi: 10.1002/bjs.1800840917.
    1. Cherrick G., Stein S., Leevy C., Davidson C. Indocyanine green: observations on its physical properties, plasma decay, and hepatic extraction. The Journal of Clinical Investigation. 1960;39:592–600. doi: 10.1172/jci104072.
    1. Teranaka M., Schenk W. G., Jr. Hepatic blood flow measurement. A comparison of the indocyanine green and electromagnetic techniques in normal and abnormal flow states in the dog. Annals of Surgery. 1977;185(1):58–63. doi: 10.1097/00000658-197701000-00009.
    1. Stone H. H., Long W. D., Smith R. B., III, Haynes C. D. Physiologic considerations in major hepatic resections. The American Journal of Surgery. 1969;117(1):78–84. doi: 10.1016/0002-9610(69)90288-8.
    1. Gottlieb M. E., James Sarfeh I., Stratton H., Goldman M. L., Newell J. C., Shah D. M. Hepatic perfusion and splanchnic oxygen consumption in patients postinjury. Journal of Trauma - Injury, Infection and Critical Care. 1983;23(9):836–843. doi: 10.1097/00005373-198309000-00009.
    1. Fan S.-T., Lai E. C. S., Lo C.-M., Ng I. O. L., Wong J. Hospital mortality of major hepatectomy for hepatocellular carcinoma associated with Cirrhosis. Archives of Surgery. 1995;130(2):198–203. doi: 10.1001/archsurg.1995.01430020088017.
    1. Sutherland F., Harris J. Claude Couinaud. Archives of Surgery. 2002;137(11) doi: 10.1001/archsurg.137.11.1305.
    1. Fong Y., Sun R. L., Jarnagin W., Blumgart L. H. An analysis of 412 cases of hepatocellular carcinoma at a Western center. Annals of Surgery. 1999;229(6):790–800. doi: 10.1097/00000658-199906000-00005.
    1. Peck-Radosavljevic M. Thrombocytopenia in liver disease. Canadian Journal of Gastroenterology. 2000;14(Supplement D):60D–66D. doi: 10.1155/2000/617428.
    1. Maithel S. K., Kneuertz P. J., Kooby D. A., et al. Importance of low preoperative platelet count in selecting patients for resection of hepatocellular carcinoma: A multi-institutional analysis. Journal of the American College of Surgeons. 2011;212(4):638–648. doi: 10.1016/j.jamcollsurg.2011.01.004.
    1. Hope-Ross M., Yannuzzi L. A., Gragoudas E. S., et al. Adverse reactions due to indocyanine green. Ophthalmology. 1994;101(3):529–533. doi: 10.1016/S0161-6420(94)31303-0.
    1. Giannini E. G., Savarino V. Platelet count and survival of patients with compensated cirrhosis and small hepatocellular carcinoma treated with surgery. Hepatology. 2014;59(4):1649–1649. doi: 10.1002/hep.26622.
    1. Pang Q., Qu K., Zhang J.-Y., et al. The prognostic value of platelet count in patients with hepatocellular carcinoma: a systematic review and meta-analysis. Medicine. 2015;94(37):p. e1431. doi: 10.1097/MD.0000000000001431.

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