Search

Purpose. Sepsis is a severe complication in patients following major hepatobiliary and pancreatic surgery. The purpose of this study was to develop and validate a nomogram based on inflammation biomarkers and clinical characteristics. Methods. Patients who underwent major hepatobiliary and pancreatic surgery between June 2015 and April 2017 were retrospectively collected. Multivariate logistic regression was used to identify the independent risk factors associated with postoperative sepsis. A training cohort of 522 patients in an earlier period was used to develop the prediction models, and a validation cohort of 136 patients thereafter was used to validate the nomograms. Results. Sepsis developed in 55 of 522 patients of the training cohort and 19 of 136 patients in the validation cohort, respectively. In the training cohort, one nomogram based on clinical characteristics was developed. The clinical independent risk factors for postoperative sepsis include perioperative blood transfusion, diabetes, operative time, direct bilirubin, and BMI. Another nomogram was based on both clinical characteristics and inflammation biomarkers. Multivariate regression analyses showed that previous clinical risk factors, PCT, and CRP were independent risk factors for postoperative sepsis. The last nomogram showed a good C -index of 0.844 (95% CI, 0.787-0.900) compared with the previous one of 0.777 (95% CI, 0.713-0.840). Patients with a total score more than 109 in the second model are at high risk. The positive predictive value and negative predictive value of the second nomogram were 27% and 97%, respectively. Conclusion. The nomogram achieved good performances for predicting postoperative sepsis in patients by combining clinical and inflammation risk factors. This model can provide the early risk estimation of sepsis for patients following major hepatobiliary and pancreatic surgery. [ABSTRACT FROM AUTHOR]

Purpose. As we all know, curative resection remains the only effective treatment for hepatocellular cancer (HCC). However, systemic inflammatory response syndrome always correlates with surgery, which may impose an impact on the clinical outcome of HCC patients who had undergone curative treatment. The present study is aimed at exploring the correlation between perioperative inflammatory mediators and recurrence risk of HCC. Methods. This study retrospectively included 157 histologically confirmed single HCC patients (88 patients developed HCC again) who had received radical hepatectomy between January 2016 and May 2018 at the Department of Hepatobiliary Surgery, the People's Liberation Army General Hospital (PLAGH), China. The cut-off values for predicting recurrence were determined by receiver operating characteristic (ROC) curve analysis with estimation of the Youden index. Recurrence-free survival (RFS) was assessed using the Kaplan-Meier method, and the difference was compared between groups by the log-rank test. Univariate/multivariate analysis was performed to identify independent risk factors of postoperative tumor recurrence. Results. The perioperative serum IL1, IL2, and IL10 levels showed no difference between groups, whereas the serum IL6, IL8, and TNF-α levels showed significant differences between groups. High preoperative serum IL6, IL8, and TNF-α levels were significantly associated with shorter RFS. Multivariate analysis revealed that preoperative serum IL6>8.45 pg/ml, preoperative serum IL8>68 pg/ml, preoperative serum TNF−α>14.9 pg/ml, microvascular invasion (MVI), and maximum tumor size>6 cm were independent predictors of RFS. Conclusions. The present study confirmed that high preoperative serum IL6, IL8, and TNF-α levels were distinctly correlated with the postoperative tumor recurrence risk of HCC patients. [ABSTRACT FROM AUTHOR]