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Original Article
March 1, 2008

Prognostic Utility of Postoperative C-reactive Protein for Posthepatectomy Liver Failure

Author Affiliations

Author Affiliations: Division of Hepatobiliary and Transplant Surgery, St James's University Hospital, Leeds, England. Dr Rahman is now with Royal Free Hospital, London, England.

Arch Surg. 2008;143(3):247-253. doi:10.1001/archsurg.2007.75

Hypothesis  C-reactive protein (CRP) is an acute-phase protein produced by the liver. We hypothesize that an early dampened CRP response after major liver resection is of prognostic importance in predicting posthepatectomy liver failure (PHLF).

Design  Serum CRP levels were determined on postoperative days 1, 3, and 7 in patients undergoing liver resection (stratified into minor [≤2 segments], standard [3 or 4 segments], and extended [≥5 segments]). Correlations were made with indices of PHLF (hyperbilirubinemia, coagulopathy, ascites, and encephalopathy), multi-organ dysfunction syndrome, sepsis, and death.

Setting  Division of Hepatobiliary and Transplant Surgery, Leeds Teaching Hospitals National Health Service Trust, England.

Patients  One hundred thirty-eight individuals who underwent liver resection.

Main Outcome Measures  Sepsis, PHLF, and mortality.

Results  A total of 138 liver resections (39 minor, 51 standard, and 48 extended) were included. Median serum CRP levels on day 1 were significantly lower after extended liver resection (28 mg/L; range, 5-119 mg/L [to convert to nanomoles per liter, multiply by 9.524]) compared with standard resection (41 mg/L; range, 5-85 mg/L) and minor resection (51 mg/L; range, 8-203 mg/L; χ2 = 19; P < .001). Similar differences were observed on day 3 (χ2 = 27; P < .001). Postoperative day 1 CRP levels were significantly lower in patients developing PHLF (hyperbilirubinemia, P = .001; ascites, P < .001; coagulopathy, P = .002; and encephalopathy, P < .001) or multiorgan dysfunction syndrome (P = .009) or who died (P = .01). Day 1 serum CRP levels and extent of resection were independent predictors of PHLF in multivariate analysis.

Conclusion  The early dampened CRP response after major liver resection may reflect poor hepatic reserve that could have prognostic utility.