Low immediate postoperative platelet count is associated with hepatic insufficiency after hepatectomy

Table 1 Patient characteristics in patients with low or high platelet count after major liver resection n (%)

Clinical characteristics	Low platelet group(n = 146)	High platelet group(n = 419)	P value
Male	131 (89.7)	353 (84.2)	0.104
Age > 65 yr	23 (15.8)	51 (12.2)	0.269
Preoperative platelet < 100 × 109/L	79 (54.1)	28 (6.7)	< 0.001
ASA grade			0.058
I-II	117 (80.1)	369 (88.1)
III	24 (16.4)	42 (10.0)
IV	5 (3.4)	8 (1.9)
BMI (kg/m2), mean (SD)	22.93 (2.80)	22.90 (2.83)	0.941
Esophageal varices	22 (15.1)	47 (11.2)	0.221
Hypertension	30 (20.5)	66 (15.8)	0.184
Cardiovascular disease	3 (2.1)	12 (2.9)	0.822
Pulmonary disease	3 (2.1)	9 (2.1)	1.000
Diabetes mellitus	22 (15.1)	26 (76.2)	0.001
HBsAg	124 (84.9)	330 (78.8)	0.106
HBeAg	22 (15.1)	58 (13.8)	0.714
HBV DNA > 2000 U/mL	51 (34.9)	135 (32.2)	0.548
AST (U/L) > ULN	68 (46.6)	194 (46.3)	0.954
ALT (U/L) > ULN	49 (33.6)	133 (31.7)	0.685
Total bilirubin (μmol/L), median (IQR)	14.5 (10.3-18.6)	12.9 (9.9-18.0)	0.145
Albumin (g/L), median (IQR)	40.9 (43.1-37.6)	40.5 (37.6-43.2)	0.538
Hemoglobin (g/L), median (IQR)	141 (129-150)	140 (127-152)	0.913

BMI: Body mass index; HBsAg: Hepatitis B surface antigen; HBeAg: Hepatitis B e antigen; SD: Standard deviation; ULN: Upper limit of normal; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; ASA: American Society of Anesthesiologists category; IQR: Interquartile range.

Table 2 Intraoperative and postoperative parameters in patients with low or high platelet count after major liver resection n (%)

Intraoperative parameters	Low platelet group(n = 146)	High platelet group(n = 419)	P value
Liver volume removed			0.140
< 35%	61 (41.8)	215 (51.3)
35%-65%	38 (26.0)	91 (21.7)
> 65%	47 (32.2)	113 (27.0)
Extrahepatic procedures	33 (22.6)	90 (21.5)	0.777
Liver resection with			0.883
Hooking with ligation	35 (24.0)	103 (24.6)
Ultrasonic dissection	111 (76.0)	316 (75.4)
Inflow occlusion	60 (41.4 )	191 (45.6)	0.347
Anatomic resection	94 (64.4)	293 (69.9)	0.214
Blood loss (mL), mean (SD)	765 (1011)	583 (436)	0.036
PRBCs transfusion	58 (39.7)	105 (25.1)	0.001
Total complication	63 (43.2)	150 (35.8)	0.114
III-V grade complication	30 (20.5)	52 (12.4)	0.016
Mortality	10 (6.8)	2 (0.5)	< 0.001
Liver failure	10 (6.8)	11 (2.6)	0.020
Hepatic insufficiency	46 (31.5)	89 (21.2)	0.012
ICU stay (d), median (IQR)	0 (0-1)	0 (0-1)	0.129
Hospital stay (d), median (IQR)	14 (12-18)	13 (11-16)	0.011

PRBC: Packed red blood cell; IQR: Interquartile range; SD: Standard deviation; ICU: Intensive care unit.

Table 3 Patient parameters in patients with or without liver dysfunction after major liver resection

Parameters	Liver dysfunction (n = 135)	No Liver dysfunction (n = 430)	OR (95%CI)	P value
Male	127 (94.1)	357 (83.0)	2.87 (1.42-5.79)	0.001
Age > 65 yr	12 (8.9)	62 (14.4)	0.58 (0.30-1.11)	0.097
Preoperative platelet < 100 × 109/L	37 (27.4)	70 (16.3)	1.94 (1.23-3.07)	0.004
Postoperative platelet < 100 × 109/L	46 (34.1)	100 (23.3)	1.71 (1.12-2.60)	0.012
BMI (kg/m2), mean (SD)	22.9 (21.2-25.0)	22.5 (20.9-24.5)	Not available	0.147
Esophageal varices	36 (26.7)	33 (7.7)	4.38 (2.60-7.37)	0.001
Hypertension	22 (16.3)	74 (17.2)	0.94 (0.56-1.58)	0.805
Cardiovascular disease	4 (3.0)	11 (2.6)	1.16 (0.36-3.71)	0.799
Pulmonary disease	2 (1.5)	10 (2.3)	0.63 (0.14-2.92)	0.802
Diabetes mellitus	10 (7.4)	38 (8.8)	0.83 (0.4-1.70)	0.603
ASA III-IV	17 (12.6)	62 (14.4)	0.86 (0.48-1.52)	0.594
HBsAg	119 (88.1)	335 (77.9)	2.11 (1.19-3.73)	0.009
HBeAg	24 (17.8)	56 (13.0)	1.44 (0.86-2.44)	0.167
HBV DNA > 2000 U/mL	47 (34.8)	139 (32.3)	1.12 (0.74-1.68)	0.591
AST (U/L) > ULN	75 (55.6)	187 (43.5)	1.62 (1.1-2.40)	0.014
ALT (U/L) > ULN	55 (40.7)	127 (29.5)	1.64 (1.10-2.50)	0.015
Total bilirubin (μmol/L), median (IQR)	16.1 (11.4-20.5)	12.5 (9.6-17.4)	Not available	< 0.001
Hemoglobin (g/L), median (IQR)	146 (131-157)	139 (127-150)	Not available	0.001
Liver volume removed				< 0.001
< 35%	15 (11.1)	145 (33.7)	1 (reference)
35%-65%	32 (23.7)	97 (22.6)	3.19 (1.64-6.20)
> 65%	88 (65.2)	188 (43.7)	4.53 (2.51-8.15)
Extrahepatic procedures	37 (27.4)	86 (20.0)	1.51 (0.97-2.36)	0.069
Liver resection with				0.248
Hooking with ligation	38 (28.1)	100 (23.3)	1.29 (0.84-2.0)
Ultrasonic dissection	97 (71.9)	330 (76.7)	0.77 (0.5-1.20)
Inflow occlusion	54 (40.0)	197 (45.8)	1.27 (0.86-1.88)	0.236
Anatomic resection	98 (72.6)	289 (67.2)	1.29 (0.84-1.98)	0.240
Blood loss (mL), mean (SD)	770 (1049)	585 (433.0)	Not available	0.003
PRBCs transfusion	47 (34.8)	116 (27.0)	1.45 (0.96-2.19)	0.080
Hospital stay (d), median (IQR)	14 (11-19)	13 (11-16)	Not available	0.001

BMI: Body mass index; HBsAg: Hepatitis B surface antigen; HBeAg: Hepatitis B e antigen; SD: Standard deviation; ULN: Upper limit of normal; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; IQR: Interquartile range.

Table 4 Multivariate analysis of independent risk factor for hepatic insufficiency

Variables	Regression coefficient (β)	OR (95%CI)	P value
Male	-0.993	0.393 (0.179-0.864)	0.020
Postoperative platelet	0.597	1.816 (1.138-2.899)	0.012
< 100 × 109/L
Esophageal varices	1.446	4.244 (2.405-7.491)	< 0.001
Total bilirubin	0.072	1.075 (1.042-1.108)	< 0.001
Liver volume removed (%)		1 (Ref)
35%-65%	1.185	3.271 (1.601-6.683)	0.001
> 65%	1.704	5.498 (2.908-10.394)	< 0.001