Revista de hipertensión: acceso abierto

Prognostic Risk Factors for Surgery in Patients with Cirrhotic Portal Hypertension

Abstract

YunFu Lv, Wan Yee Lau, XiaoYu Han1, XiaoGuany Gong, Ning Liu, Qingyong Ma, YongBin Pang, Jie Yue and YeJuan Li

Background: In the clinical management of cirrhotic portal hypertension, surgery is often necessary; however, the operative mortality rate is high.

Methods: Data from 161 patients who underwent surgery for cirrhotic portal hypertension were analyzed, and 24 potential predictors of surgical outcome were assessed. A Kruskal Wallis rank sum test was used for single-factor comparisons, and multivariate logistic regression for multi-factor comparisons to identify risk factors for poor surgical outcomes and calculate their scores.

Results: Six predictors of poor surgical outcomes were identified: postoperative bleeding within 30h of >2L, with a score of 3; severe liver atrophy (an anteroposterior diameter of the left lobe of ≤55 mm and an oblique diameter of the right lobe ≤ 110mm), with a score of 3; a base excess of <-3mmol/L, with a score of 3; a platelet count of <3T/L, with a score of 2; an amount of intraoperative bleeding of >2 L, with a score of 2; and a red blood cell count of <3G/L, with a score of 1. For patients with a good outcome (n=147), all patients had a score of ≤ 3, except one patient who had a score of 4. With respect to patients that died (n=14), all had a score of ≥ 5, except one patient who had a score of 4. A significant difference was observed between the two groups (P<0.05). The mortality was 100% in patients with a score of ≥ 7.

Conclusions: Six risk factors for poor surgical outcomes were identified in this study. Operative mortality appears to be significantly increased in patients with a score of 5-6. Surgery should be contraindicated in patients with a score of ≥ 7. To reduce mortality, close attention should be paid to preoperative and intraoperative treatment and prevention to achieve a score of <4.