Early postoperative arterial lactate concentrations to stratify risk of post-hepatectomy liver failure
Abstract
Background Post-hepatectomy liver failure (PHLF) represents the major determinant for death after liver resection. Early recognition is essential. Perioperative lactate dynamics for risk assessment of PHLF and associated morbidity were evaluated. Methods This was a multicentre observational study of patients undergoing hepatectomy with validation in international high-volume units. Receiver operating characteristics analysis and cut-off calculation for the predictive value of lactate for clinically relevant International Study Group of Liver Surgery grade B/C PHLF (clinically relevant PHLF (CR-PHLF)) were performed. Lactate and other perioperative factors were assessed in a multivariable CR-PHLF regression model. Results The exploratory cohort comprised 509 patients. CR-PHLF, death, overall morbidity and severe morbidity occurred in 7.7, 3.3, 40.9 and 29.3 per cent of patients respectively. The areas under the curve (AUCs) regarding CR-PHLF were 0.829 (95 per cent c.i. 0.770 to 0.888) for maximum lactate within 24 h (Lactate_Max) and 0.870 (95 per cent c.i. 0.818 to 0.922) for postoperative day 1 levels (Lactate_POD1). The respective AUCs in the validation cohort (482 patients) were 0.812 and 0.751 and optimal Lactate_Max cut-offs were identical in both cohorts. Exploration cohort patients with Lactate_Max 50 mg/dl or greater more often developed CR-PHLF (50.0 per cent) than those with Lactate_Max between 20 and 49.9 mg/dl (7.4 per cent) or less than 20 mg/dl (0.5 per cent; P…
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PHLF may lead to subsequent complications such as infection, bleeding, and kidney failure.
“This is crucial as PHLF may lead to subsequent complications such as infection, bleeding, and kidney failure [10,13,14].”
From The Role of Perioperative Interleukin-6 Serum Levels on Liver Dysfunction and Infectious Complications After Hepatectomy—A Systematic Review (2025) · cites this paper as [13]
Serum lactate, CRP, and antithrombin III were demonstrated to identify imminent PHLF as early as within 24 h of surgery.
“More recently, markers such as serum lactate, CRP, and antithrombin III were demonstrated to identify imminent PHLF as early as within 24 h of surgery [11,12,13].”
From The Role of Perioperative Interleukin-6 Serum Levels on Liver Dysfunction and Infectious Complications After Hepatectomy—A Systematic Review (2025) · cites this paper as [13]
Postoperative liver function mainly determines the overall course and subsequent morbidity after major hepatectomy.
“Especially in major hepatectomies, the postoperative liver function mainly determines the overall course and subsequent morbidity [7,13,35].”
From The Role of Perioperative Interleukin-6 Serum Levels on Liver Dysfunction and Infectious Complications After Hepatectomy—A Systematic Review (2025) · cites this paper as [13]
Most publications are underpowered to assess CR-PHLF with event rates of 5-15%, with commonly less than 50 patients included per study.
“With commonly less than 50 patients included per study, most publications are underpowered to assess CR-PHLF with event rates of 5–15% according to the literature [5,7,13,38,39].”
From The Role of Perioperative Interleukin-6 Serum Levels on Liver Dysfunction and Infectious Complications After Hepatectomy—A Systematic Review (2025) · cites this paper as [13]
Cited by
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Primavesi, F., Maglione, M., Cipriani, F., Denecke, T., Oberkofler, C. E., Starlinger, P., Dasari, B. V. M., Heil, J., Sgarbura, O., Søreide, K., et al. (2023) · British Journal of Surgery · doi:10.1093/bjs/znad233 · Cited by 97 · see citing works
Self-citationKofler, A., Trattner, M., Mairinger, V., Urban, I., Søreide, K., Stättner, S., & Primavesi, F. (2025) · Cancers · doi:10.3390/cancers17193120 · Cited by 4 · see citing works
“This is crucial as PHLF may lead to subsequent complications such as infection, bleeding, and kidney failure [10,13,14].”
InfluentialSelf-citationPrimavesi, F., Senoner, T., Schindler, S., Nikolajevic, A., Di Fazio, P., Csukovich, G., Eller, S., Neumayer, B., Anliker, M., Braunwarth, E., et al. (2024) · Antioxidants · doi:10.3390/antiox13050590 · Cited by 3 · see citing works
Self-citation
- Authors
- Niederwieser, T., Braunwarth, E., Dasari, B. V. M., Pufal, K., Szatmary, P., Hackl, H., Haselmann, C., Connolly, C. E., Cardini, B., Öfner, D., Roberts, K., Malik, H., Stättner, S., & Primavesi, F.
- Affiliations
- Innsbruck Medical University (AT)
- Queen Elizabeth Hospital Birmingham (GB)
- Aintree University Hospitals NHS Foundation Trust (GB)
- Corresponding author
- Primavesi, Florian
- ORCID
- Venue
- British Journal of Surgery
- Publisher
- Oxford University Press (OUP)
- Published
- 2021-10-25
- Volume
- 108
- Issue
- 11
- Pages
- 1360-1370
- ISSN
- 0007-1323 (ISSN-L)
- 1365-2168
- OpenAlex
- W3208267048
- Cited by
- 39
- References
- 0
- Citations by year
- 2026: 8 · 2025: 11 · 2024: 10 · 2023: 5 · 2022: 5
- FWCI
- 2.78
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
- Locations
- British journal of surgery (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute for Health and Care Research (CL-2018-07-003)
- Topics
- Health Sciences › Medicine › Hepatology › Hepatocellular Carcinoma Treatment and Prognosis
- Health Sciences › Medicine › Surgery › Organ Transplantation Techniques and Outcomes
- Health Sciences › Medicine › Surgery › Enhanced Recovery After Surgery
- Keywords
- post-hepatectomy liver failure, arterial lactate, hepatectomy, risk stratification, early postoperative monitoring, acute kidney injury, postoperative bleeding, liver resection outcomes, mortality prediction, prognostic factors, postoperative morbidity
- MeSH terms
- Aged, Austria, Female, Hepatectomy, Humans, Male, Middle Aged, Postoperative Complications, Prognosis, Retrospective Studies, Risk Factors, Biomarkers, Incidence, Liver Failure, Risk Assessment, Lactic Acid
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