TY - JOUR
T1 - Modulation of plasma fibrinogen levels in acute phase response after hepatectomy
AU - Giovannini, Ivo
AU - Chiarla, Carlo
AU - Giuliante, Felice
AU - Vellone, Maria
AU - Nuzzo, Gennaro
PY - 2004
Y1 - 2004
N2 - In acutephase response, the use of amino acids is redirected to supporting the synthesis of proteins for host defence and tissue repair. Fibrinogen is one of these proteins, and its plasma levels commonly increase in acutephase conditions. After hepatectomy, this pattern may be modified by the variable impact of postoperative liver dysfunction. Our study was performed to specifically assess and quantify this aspect. Data were collected prospectively on 82 hepatectomized patients; 62 recovered normally, 20 had major complications (most commonly sepsis). Plasma fibrinogen and a large series of complementary variables were determined preoperatively and at postoperative days 1, 3 and 7 in all patients and until recovery, or death in those with complications. Multiple regression analysis showed that postoperative changes in fibrinogen (DeltaFIB, mumol/l) were simultaneously related to the number of resected liver segments (NSEG), total bilirubin (BIL, mumol/l), aspartate aminotransferase (AST, U/l, n.v. 545), albumin (ALB, g/l), prothrombin activity (PA, % of standard reference), age (AGE, years) and basal preoperative fibrinogen (PFIB, mumol/l): DeltaFIB= -0.51 (NSEG) -0.71 (Log(n)BIL) -0.74(Log(n)AST)+0.11(ALB) +0.09(PA) -0.06 (AGE) -0.55(PFIB)+7.74 (n=362, r(2)=0.68, p<0.001). In addition, an early postoperative tendency for low fibrinogen was associated with the subsequent development of complications or death. Our study quantifies the impact of size of hepatectomy and dysfunction of residual liver in modulating postoperative fibrinogen level and suggests that failure of fibrinogen to increase may signal an unfavorable condition limiting upregulation of acutephase response and increasing liability to complications.
AB - In acutephase response, the use of amino acids is redirected to supporting the synthesis of proteins for host defence and tissue repair. Fibrinogen is one of these proteins, and its plasma levels commonly increase in acutephase conditions. After hepatectomy, this pattern may be modified by the variable impact of postoperative liver dysfunction. Our study was performed to specifically assess and quantify this aspect. Data were collected prospectively on 82 hepatectomized patients; 62 recovered normally, 20 had major complications (most commonly sepsis). Plasma fibrinogen and a large series of complementary variables were determined preoperatively and at postoperative days 1, 3 and 7 in all patients and until recovery, or death in those with complications. Multiple regression analysis showed that postoperative changes in fibrinogen (DeltaFIB, mumol/l) were simultaneously related to the number of resected liver segments (NSEG), total bilirubin (BIL, mumol/l), aspartate aminotransferase (AST, U/l, n.v. 545), albumin (ALB, g/l), prothrombin activity (PA, % of standard reference), age (AGE, years) and basal preoperative fibrinogen (PFIB, mumol/l): DeltaFIB= -0.51 (NSEG) -0.71 (Log(n)BIL) -0.74(Log(n)AST)+0.11(ALB) +0.09(PA) -0.06 (AGE) -0.55(PFIB)+7.74 (n=362, r(2)=0.68, p<0.001). In addition, an early postoperative tendency for low fibrinogen was associated with the subsequent development of complications or death. Our study quantifies the impact of size of hepatectomy and dysfunction of residual liver in modulating postoperative fibrinogen level and suggests that failure of fibrinogen to increase may signal an unfavorable condition limiting upregulation of acutephase response and increasing liability to complications.
KW - Acute phase response
KW - Hepatectomy
KW - Hypofibrinogenemia
KW - Morbidity
KW - Mortality
KW - Acute phase response
KW - Hepatectomy
KW - Hypofibrinogenemia
KW - Morbidity
KW - Mortality
UR - http://hdl.handle.net/10807/14802
U2 - 10.1515/CCLM.2004.048
DO - 10.1515/CCLM.2004.048
M3 - Article
SN - 1434-6621
VL - 42
SP - 261
EP - 265
JO - Clinical Chemistry and Laboratory Medicine
JF - Clinical Chemistry and Laboratory Medicine
ER -