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Master Thesis

Intérêt de la clairance hépatique au vert d’indocyanine par le moniteur Limon® dans la prédiction d’une insuffisance hépatocellulaire post hépatectomie

Abstract : Purpose: Determine capacity to predict posthepatectomy liver failure (PHLF) at 5 day by indocyanine green liver elimination measured with Limon monitor ®. Methods: After agreement of ethic comity, this prospective observational, monocentric study interested on liver resections during 12 months (December 2011-April 2012 and December 2012-June 2013). Plasma disappearance rate of ICG Liver elimination ICG (PDR ICG %/min) and retention rate at 15 min (R15 en %) was realized in preoperative (PDR0, R150) and immediately after the surgery (PDR1 and R151) in patient with hemodynamic stability. PHLF was defined by a hyperbilirubinemia (>50µmol/L) and/or a TP inferior to 50% at postoperative 5 day. Statistical analysis featured student t test and a Mann Whithney U test. Area under curve (ROC) was determined for PDR ICG and R15. Optimal threshold was obtained by Youden method. Results: Of the 60 included patient, half (54%) undergone surgery for metastasectomy which 45% were secondary to colorectal carcinoma. Our study focuses on the PHLF, the most severe risk factor in case of hepatectomy, that 10 patients (17%) presented. In fact, patients who developed PHLF have a PDR0 dramatically impaired than other patients (15.8%/mn [19.8-11.8] versus 22.1%/mn [12.7-34.4], p=0.01) and an increase of R150 (10.9% [5.0-16.8] versus 7.7% [0.1-18.1], p=0.01). Similarly, patients with PHLF present an impairment of PDR1 than other patients (8.7%/mn [6.1-11.3] versus 16.8%/mn [10.9-22.7], p<0.0001) and an increase of R151 (30.1% [16.1-43.9] versus 11.4% [2.5-20.3], p<0.0001). According to the Youden’s method, the threshold value of PDR0 is 18.3%/mn (Se 90%/Sp 64%) and this of R150 is 6.3% (Se 90%/Sp 62%). Moreover, patients with PDR1 less than 10.7%/mn (Se 90%/Sp 86%) and R151 higher than 15.4% (Se 100%/78%) have a risk to develop PHLF at five day. Conclusion: Perioperative hepatectomy measure of liver elimination can help clinician to assess patient risk to develop PHLV at 5 day.
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https://dumas.ccsd.cnrs.fr/dumas-01084153
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Submitted on : Tuesday, November 18, 2014 - 4:02:10 PM
Last modification on : Wednesday, August 23, 2017 - 4:33:36 PM
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Margot Lamarque. Intérêt de la clairance hépatique au vert d’indocyanine par le moniteur Limon® dans la prédiction d’une insuffisance hépatocellulaire post hépatectomie. Médecine humaine et pathologie. 2014. ⟨dumas-01084153⟩

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