Key result
A primary decrease in arterial ketone body ratio below 0.4 at the end of hepatectomy was associated with 50% total mortality, compared to 7% in patients with a ratio above 0.7.
Why the study?
Does the primary decrease in arterial ketone body ratio after hepatectomy predict prognosis and mortality in hepatectomized patients?
Cohort (n=266)
Does the primary decrease in arterial ketone body ratio after hepatectomy predict prognosis and mortality in hepatectomized patients?
The primary decrease in arterial ketone body ratio at the end of hepatectomy is a decisive prognostic factor for mortality and multiple organ failure.
Answers are grounded in this paper and cite their sources.
May signal high postoperative mortality risk after hepatectomy; leaves open prospective validation as a prognostic marker.
Postoperative fluctuations of the ketone body ratio in arterial blood (acetoacetate/3-hydroxybutyrate), reflecting hepatic mitochondrial redox potential, were analyzed in 266 hepatectomized patients in relation to their prognosis. Changes in ketone body ratio were classified into the following two types: a primary decrease at the end of operation and a secondary decrease after transient recovery. Patients were classified into three groups by the primary decrease of ketone body ratio: group 1 (183 cases) with ketone body ratio above 0.7, group 2 (49 cases) between 0.7 and 0.4, and group 3 (34 cases) below 0.4 Ketone body ratio was restored to above 0.7 in 2.5 +/- 0.2 days (mean +/- SE) in all group 2 patients. However, though it was restored within 4.5 +/- 0.4 days in 26 group 3 patients, the other 8 died of multiple organ system failure in 7.4 +/- 2.8 days without recovery of ketone body ratio. This was followed by a secondary decrease in ketone body ratio to below 0.7 in 94 patients, concomitant with complications. The degree of the secondary decrease was positively correlated with that of the primary decrease. In the secondary decrease, of 42 patients with ketone body ratio below 0.4, 28 died of multiple organ failure. Total mortality was 7% in group 1, 12% in group 2, and 50% in group 3. It is suggested that the primary decrease in ketone body ratio at the end of operation is a decisive factor in the prognosis for hepatectomized patients.
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Tetsuya Kiuchi (1990) conducted a cohort in Hepatectomized patients (n=266). Primary decrease in arterial ketone body ratio (<0.4) vs. Ketone body ratio >0.7 was evaluated on Total mortality. A primary decrease in arterial ketone body ratio below 0.4 at the end of hepatectomy was associated with 50% total mortality, compared to 7% in patients with a ratio above 0.7.
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