5 research outputs found
Intraoperative Hyperglycemia during Liver Resection: Predictors and Association with the Extent of Hepatocytes Injury
<div><p>Background</p><p>Patients undergoing liver resection are at risk for intraoperative hyperglycemia and acute hyperglycemia is known to induce hepatocytes injury. Thus, we aimed to evaluate whether intraoperative hyperglycemia during liver resection is associated with the extent of hepatic injury.</p><p>Methods</p><p>This 1 year retrospective observation consecutively enrolled 85 patients undergoing liver resection for hepatocellular carcinoma. Blood glucose concentrations were measured at predetermined time points including every start/end of intermittent hepatic inflow occlusion (IHIO) <i>via</i> arterial blood analysis. Postoperative transaminase concentrations were used as surrogate parameters indicating the extent of surgery-related acute hepatocytes injury.</p><p>Results</p><p>Thirty (35.5%) patients developed hyperglycemia (blood glucose > 180 mg/dl) during surgery. Prolonged (≥ 3 rounds) IHIO (odds ratio [OR] 7.34, <i>P</i> = 0.004) was determined as a risk factors for hyperglycemia as well as cirrhosis (OR 4.07, <i>P</i> = 0.022), lower prothrombin time (OR 0.01, <i>P</i> = 0.025), and greater total cholesterol level (OR 1.04, <i>P</i> = 0.003). Hyperglycemia was independently associated with perioperative increase in transaminase concentrations (aspartate transaminase, β 105.1, standard error 41.7, <i>P</i> = 0.014; alanine transaminase, β 81.6, standard error 38.1, <i>P</i> = 0.035). Of note, blood glucose > 160 or 140 mg/dl was not associated with postoperative transaminase concentrations.</p><p>Conclusions</p><p>Hyperglycemia during liver resection might be associated with the extent of hepatocytes injury. It would be rational to maintain blood glucose concentration < 180 mg/dl throughout the surgery in consideration of parenchymal disease, coagulation status, lipid profile, and the cumulative hepatic ischemia in patients undergoing liver resection for hepatocellular carcinoma.</p></div
Probability of intraoperative hyperglycemia in relation to the increase in prothrombin time internationalized ratio and serum total cholesterol concentration.
<p>Probability of intraoperative hyperglycemia in relation to the increase in prothrombin time internationalized ratio and serum total cholesterol concentration.</p
Significant difference in perioperative increase of AST (‘x’ mark) and ALT (‘o’ mark) according to the occurrence of intraoperative hyperglycemia (HG).
<p>Significant difference in perioperative increase of AST (‘x’ mark) and ALT (‘o’ mark) according to the occurrence of intraoperative hyperglycemia (HG).</p
Up-and-down blood glucose fluctuation in response to clamping (C) and unclamping (U) of intermittent hepatic inflow occlusion (IHIO). I, anesthetic induction.
<p>Up-and-down blood glucose fluctuation in response to clamping (C) and unclamping (U) of intermittent hepatic inflow occlusion (IHIO). I, anesthetic induction.</p
Multivariate analysis for intraoperative hyperglycemia during liver resection.
<p>Due to concern of multicollinearity prothrombin time and total cholesterol level were separately enrolled into the multivariate model. Odds ratio and P values of other variables were described based on the model with prothrombin time internationalized ratio (INR).</p><p>Multivariate analysis for intraoperative hyperglycemia during liver resection.</p