Introduction
Methods
Patients
Preoperative biliary drainage
HBP surgery
The DIC score
Characteristics | Score |
---|---|
Systemic inflammatory response syndrome criteria | |
≥ 3 | 1 |
0–2 | 0 |
Platelet count, × 109/L | |
< 80 or > 50% decrease within 24 h | 3 |
≥ 80 and < 120, or > 30% decrease within 24 h | 1 |
≥ 12 | 0 |
Prothrombin time (value of patient/normal value) | |
≥ 1.2 | 1 |
< 1.2 | 0 |
Fibrin/fibrinogen degradation products, mg/L | |
≥ 25 | 3 |
≥ 10 and < 25 | 1 |
< 1 | 0 |
Diagnosis ≥ 4 points | DIC |
Statistical analysis
Results
Correlation between surgery-related DIC and clinical characteristics
Variables | n = 100 |
---|---|
Age (years) | 69.5 [64–77] |
Male/Female | 77/23 |
Diagnosis | |
HCC | 42 (42%) |
Pancreatic cancer | 8 (8%) |
Cholangiocarcinoma | 22 (22%) |
Duodenal cancer | 14 (14%) |
Gall bladder cancer | 5 (5%) |
Combined hepatocellular and cholangiocarcinoma | 2 (2%) |
Biliary injury | 1 (1%) |
Duodenal gastrinoma | 1 (1%) |
IPMN of pancreas | 1 (1%) |
Others | 4 (4%) |
Surgical procedure | |
+ Pancreaticoduodenectomy | 27 (27%) |
+ Liver resection | 74 (74%) |
+ Biliary tract reconstruction | 47 (47%) |
DIC | Non-DIC | ||
---|---|---|---|
(%) or [IQR] | N = 24 | N = 76 | P-value |
Male/ Female | 22 (91.6) | 55 (72.3) | 0.05 |
Age (years) | 69.5 [64–78] | 69.5 [64–77] | 0.79 |
BMI (kg/m2) | 21.9 [19.4–23.1] | 21.9 [20.0–23.8] | 0.68 |
Diabetes, yes | 7 (29.1) | 24 (31.6) | 0.82 |
Preoperative biliary drainage | 3 (12.5) | 21 (27.6) | 0.13 |
Cholangitis in medical history | 1 (4.1) | 4 (5.2) | 1.00 |
Benign | 0 (0) | 5 (6.6) | 0.33 |
Hepatectomy | 19 (79.1) | 55 (72.4) | 0.51 |
Pancreatectomy | 5 (20.8) | 23 (30.2) | 0.37 |
Biliary tract reconstruction | 9 (37.5) | 38 (50.0) | 0.28 |
Lymph node dissection | 11 (45.8) | 41 (53.9) | 0.49 |
Operation time (min) | 470 [376–705] | 441 [367–516] | 0.27 |
Bleeding volume (mL) | 936 [631–2,191] | 547 [360–890] | < 0.01 |
T-bil (mg/dL) | 0.6 [0.6–1.1] | 0.6 [0.6–1.1] | 0.83 |
AST(IU/L) | 48 [31–74] | 27 [21–43] | < 0.01 |
ALP (IU/L) | 392 [285–595] | 299 [227–463] | 0.19 |
Albumin (mg/dL) | 4.1 [3.8–4.5] | 3.9 [3.5–4.5] | 0.23 |
PT-INR (%) | 1.1 [1.0–1.2] | 1.1 [1.0–1.2] | 0.23 |
WBC (/μL) | 5,910[5,200–6,190] | 5,860 [4,740–6,780] | 0.75 |
Hemoglobin (mg/dL) | 12.3 [11.0–14.3] | 13.2 [12–14.6] | 0.17 |
Platelet (× 104/μL) | 18.1 [13.3–26.6] | 19.3 [15.6–24.1] | 0.65 |
ALBI score | -0.42 [-0.50–0.32] | -0.43 [-0.50–0.32] | 0.96 |
Clinical outcomes based on surgery-related DIC
(%) or [IQR] | DIC 24 cases | Non-DIC 76 cases | P-value |
---|---|---|---|
SSI | 11 (45.8) | 16 (21.1) | 0.02 |
Cholangitis | 6 (25.0) | 8 (10.5) | 0.07 |
Bile leakage | 2 (8.3) | 9 (11.8) | 1.00 |
Pancreatic Fistula | (16.7) | (5.3) | 0.09 |
Bloodstream infection | 5 (20.8) | 4 (5.3) | 0.03 |
ICU readmission rate | 2 (8.3) | 2 (2.6) | 0.24 |
Postoperative bleeding | 1 (4.2) | 2 (2.6) | 0.57 |
RBC infusion | 7 (29.2) | 9 (11.8) | 0.04 |
FFP infusion | 10 (41.7) | 13 (17.1) | 0.01 |
Stay in ICU (days) | 2 [0–3] | 1 [0–2] | < 0.01 |
Hospitalization periods (days) | 22 [17–41] | 19 [12-31] | 0.19 |
30-day morbidity | 23 (95.8) | 41 (54.0) | < 0.01 |
90-day mortality | 0 (0) | 2 (2.6) | 1.00 |
Risk factors for surgery-related DIC on day 1
Risk factors for high CCI without and with adjustment of surgery-related DIC on day 1
Discussion
Univariate analysis | Multivariate analysis | |||||
---|---|---|---|---|---|---|
Subject | OR | CI | P-value | OR | CI | P-value |
Gender Male | 4.20 | 0.91–19.44 | 0.07 | |||
Age, years | 1.01 | 0.96–1.06 | 0.66 | 1.02 | 0.96–1.08 | 0.57 |
BMI, kg/m2 | 0.96 | 0.83–1.11 | 0.58 | |||
Diabetes | 0.89 | 0.32–2.43 | 0.82 | |||
Preoperative biliary drainage | 0.37 | 0.10–1.38 | 0.14 | |||
Cholangitis in medical history | 0.78 | 0.08–7.36 | 0.83 | |||
Preoperative blood test | ||||||
ALBI score | 0.92 | 0.04–1.08 | 0.96 | |||
AST+10, U/L | 1.24 | 1.06–1.45 | < 0.01 | 1.23 | 1.05–1.45 | < 0.01 |
PT, | 6.72 | 0.19–238.3 | 0.30 | |||
Platelet. 104/μl | 1.00 | 0.94–1.07- | 0.91 | |||
Operation factor | ||||||
Biliary tract reconstruction | 0.60 | 0.23–1.53 | 0.29 | |||
Lymph node dissection | 0.72 | 0.28–1.81 | 0.48 | |||
Operation time, h | 1.20 | 1.02–1.42 | 0.02 | 1.22 | 1.02–1.46 | 0.02 |
Bleeding volume +100, ml | 1.05 | 1.01–1.09 | 0.01 | |||
Hepatectomy | 1.45 | 0.48–4.39 | 0.50 |
Univariate analysis | Multivariate analysis without adjustment for DIC | Multivariate analysis with adjustment for DIC | |||||||
---|---|---|---|---|---|---|---|---|---|
Subject | OR | CI | P-value | OR | CI | P-value | OR | CI | P-value |
Preoperative factor | |||||||||
Gender Male | 2.98 | 0.63–13.98 | 0.16 | ||||||
Age, years | 1.02 | 0.96–1.09 | 0.60 | 1.04 | 0.97–1.11 | 0.27 | 1.04 | 0.96–1.12 | 0.34 |
BMI, kg/m2 | 0.93 | 0.80–1.10 | 0.41 | ||||||
Diabetes | 1.03 | 0.33–2.84 | 0.95 | ||||||
Biliary drainage | 2.20 | 0.75–6.43 | 0.15 | ||||||
Cholangitis in medical history | 3.05 | 0.47–19.74 | 0.24 | ||||||
ALBI score | 9.42 | 0.42–210.92 | 0.16 | ||||||
AST+10, U/L | 1.26 | 1.08–1.47 | < 0.01 | 1.25 | 1.06–1.47 | < 0.01 | 1.19 | 0.99–1.43 | 0.06 |
Operation factor | |||||||||
Biliary tract reconstruction | 2.25 | 0.80–6.31 | 0.12 | ||||||
Lymph node dissection | 2.33 | 0.81–6.74 | 0.12 | ||||||
Operation time, h | 1.26 | 1.05–1.50 | < 0.01 | 1.30 | 1.07–1.59 | < 0.01 | 1.23 | 0.99–1.53 | 0.06 |
Bleeding volume +100, ml | 1.02 | 0.98–1.06 | 0.24 | ||||||
Hepatectomy | 0.98 | 0.31–3.05 | 0.97 | ||||||
Perioperative factor | |||||||||
DIC on day 1 | 9.86 | 3.23–30.07 | < 0.01 | - | - | - | 6.12 | 1.82–20.47 | < 0.01 |