Prognostic utility of postoperative C-reactive protein for posthepatectomy liver failure

Hypothesis: C-reactive protein (CRP) is an acute-phase protein produced by the liver. We hypothesize that an early dampened CRP response after major liver resection is of prognostic importance in predicting posthepatectomy liver failure (PHLF). Design: Serum CRP levels were determined on postoperative days 1, 3, and 7 in patients undergoing liver resection (stratified into minor [<= 2 segments], standard [3 or 4 segments], and extended [>= 5 segments]). Correlations were made with indices of PHLF (hyperbilirubinemia, coagulopathy, ascites, and encephalopathy), multi-organ dysfunction syndrome, sepsis, and death. Setting: Division of Hepatobiliary and Transplant Surgery, Leeds Teaching Hospitals National Health Service Trust, England. Patients: One hundred thirty-eight individuals who underwent liver resection. Main Outcome Measures: Sepsis, PHLF, and mortality. Results: A total of 138 liver resections (39 minor, 51 standard, and 48 extended) were included. Median serum CRP levels on day 1 were significantly lower after extended liver resection (28 mg/L; range, 5-119 mg/L [to convert to nanomoles per liter, multiply by 9.524]) compared with standard resection (41 mg/L; range, 5-85 mg/L) and minor resection (51 mg/L; range, 8-203 mg/L; chi(2)= 19; P <.001). Similar differences were observed on day 3 (chi(2) =27; P <.001). Postoperative day I CRP levels were significantly lower in patients developing PHLF (hyperbilirubinemia, P=.001; ascites, P <.001; coagulopathy, P=.002; and encephalopathy, P <.001) or multiorgan dysfunction syndrome (P=.009) or who died (P=.01). Day 1 serum CRP levels and extent of resection were independent predictors of PHLF in multivariate analysis. Conclusion: The early dampened CRP response after major liver resection may reflect poor hepatic reserve that could have prognostic utility.