Early prediction of postoperative liver dysfunction and clinical outcome using antithrombin III-activity

Figures

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  Fig 1. Perioperative ATIII-activity dynamics. ATIII-activity was evaluated prior to surgery (PRE OP), as well as on the first (POD1) and fifth (POD5) postoperative day. Perioperative dynamics are shown in A for all patients of the evaluation cohort. Patients were divided in groups according to their resection extent (B). Further, dynamics of ATIII-activity in patients with and without postoperative liver dysfunction (LD) were assessed and are illustrated in C. Moreover, patients were grouped depending on postoperative outcome. ATIII-activity is shown for patients with or without postoperative morbidity (D), postoperative severe morbidity (SM) (E) and mortality within 90 days after surgery (F). * P < 0.05; ** P < 0.005.

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  Fig 2. ATIII-activity on POD1 competes other markers in the prediction of postoperative LD. Predictive value of ATIII-activity, CRP, fibrinogen, SB, PT, AST, ALT and GGT on POD1 to predict postoperative LD using receiver operating characteristics (ROC) analysis was compared.

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  Fig 3. ATIII-activity on POD1 predicts postoperative LD. Receiver operating characteristic (ROC) curve for ATIII-activity on POD1 in the evaluation sample. Point with confidence bars gives sensitivity and specificity for the cut-off maximizing the sum of sensitivity and specificity.

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  Fig 4. Patients with low postoperative ATIII-activity suffer from poor clinical outcome. Using a cut-off of 61.5% ATIII-activity, patients were divided in a high-risk group (ATIIIlow) and a low-risk group (ATIIIhigh). Incidence of postoperative LD, morbidity, severe morbidity (SM) and mortality are illustrated according to risk groups in our evaluation cohort (A) and were confirmed in our validation cohort (B). Overall survival (OS in %) for mCRC patients in the entire collective was assessed for both risk groups after 1, 3, 5 and 10 years (C). * P < 0.05; ** P < 0.005.

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  Fig 5. Decision tree for postoperative risk stratification. Combination of ATIII-activity and SB values on POD1 allows highly specific discrimination of patients risk for postoperative LD.