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Cited by 1,027Hepatocellular Carcinoma Treatment and PrognosisOrgan Transplantation Techniques and OutcomesLiver physiology and pathology

The ???50-50 Criteria??? on Postoperative Day 5: An Accurate Predictor of Liver Failure and Death After Hepatectomy

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Balzan, Silvio, Belghiti, Jacques, Farges, Olivier, Ogata, Satoshi, Sauvanet, Alain, Delefosse, Didier, Durand, Fran??ois·2005·Annals of Surgery
DOI 10.1097/01.sla.0000189131.90876.9ePMC PMC1409891
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Abstract

OBJECTIVE: To standardize the definition of postoperative liver failure (PLF) for prediction of early mortality after hepatectomy. SUMMARY BACKGROUND DATA: The definition of PLF is not standardized, making the comparison of innovations in surgical techniques and the timely use of specific therapeutic interventions complex. METHODS: Between 1998 and 2002, 775 elective liver resections, including 69% for malignancies and 60% major resections, were included in a prospective database. The nontumorous liver was abnormal in 43% with steatosis >30% in 14%, noncirrhotic fibrosis in 43%, and cirrhosis in 12%. The impact of prothrombin time (PT) <50% and serum bilirubin (SB) >50 micromol/L on postoperative days (POD) 1, 3, 5, and 7 was analyzed. RESULTS: The lowest PT level was observed on postoperative day (POD) 1, while the peak of SB was observed on POD 3. These 2 variables tended to return to preoperative values by POD 5. The median interval between hepatectomy and postoperative death was 15 days (range, 5-39 days). Postoperative mortality significantly increased in patients with PT <50% and SB >50 microml/L. The conjunction of PT <50% and SB >50 micromol/L on POD 5 was a strong predictive factor of mortality. In patients with significant morbidity, this "50-50 criteria" was met 3 to 8 days before clinical evidence of complications. CONCLUSIONS: The association of PT <50% and SB >50 microml/L on POD 5 (the 50-50 criteria) was a simple, early, and accurate predictor of more than 50% mortality rate after hepatectomy. This criteria could be identified early enough, before clinical evidence of complications, for specific interventions to be applied in due time.

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  • Among several definitions for PHLF, the International Study Group of Liver Surgery criteria are most accepted, based on bilirubin and prothrombin time outside normal ranges on postoperative day 5 or later.

    “Amongst several definitions for PHLF the International Study Group of Liver Surgery (ISGLS) criteria are most accepted (see Refs. [6,9,10]) based on bilirubin and prothrombin time outside normal ranges on postoperative day 5 or later.”

    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 [9]

    The Abstract and Discussion (pages not provided) support using bilirubin and prothrombin time to assess postoperative liver failure on day 5. They describe the authors’ own 50-50 criteria—prothrombin time <50% and bilirubin >50 μmol/L—not ISGLS criteria based on values outside normal ranges on day 5 or later. The copy also does not establish that ISGLS criteria are the most accepted. (LLM, conf=0.86)

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Sorted by citations

Authors
Balzan, S., Belghiti, J., Farges, O., Ogata, S., Sauvanet, A., Delefosse, D., & Durand, F.
Affiliations
Hôpital Beaujon (FR)
Corresponding author
  • Balzan, Silvio
  • Belghiti, Jacques
  • Farges, Olivier
  • Ogata, Satoshi
  • Sauvanet, Alain
ORCID
Venue
Annals of Surgery
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2005-12
Volume
242
Issue
6
Pages
824-829
ISSN
0003-4932 (ISSN-L)
DOI
10.1097/01.sla.0000189131.90876.9e
PMC
PMC1409891
OpenAlex
W2114697993
Cited by
1,027
References
0
Citations by year
2026: 33 · 2025: 36 · 2024: 55 · 2023: 46 · 2022: 60 · 2021: 75 · 2020: 69 · 2019: 64 · 2018: 66 · 2017: 82 · 2016: 72 · 2015: 74 · 2014: 56 · 2013: 55 · 2012: 50
FWCI
9.74
Type
journal article
Language
en
Open access
Locations
  • Annals of Surgery (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Hepatology › Hepatocellular Carcinoma Treatment and Prognosis
  • Health Sciences › Medicine › Surgery › Organ Transplantation Techniques and Outcomes
  • Health Sciences › Medicine › Hepatology › Liver physiology and pathology
Keywords
postoperative liver failure, hepatectomy, early mortality prediction, prothrombin time, serum bilirubin, postoperative day 5, liver cirrhosis, steatosis
MeSH terms
Female, Hepatectomy, Humans, Liver Diseases, Liver Function Tests, Male, Middle Aged, Postoperative Complications, Predictive Value of Tests, Prospective Studies, Prothrombin Time, Chi-Square Distribution, Logistic Models, Treatment Outcome, Liver Failure

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