Value of continuous monitoring of ICG-R15 in assessing hepatic insufficiency after partial hepatectomy

Objective To investigate the value of indocyanine green retention rate at 15 minutes ( ICG-R15) immediately and at 3 and 5 days after partial hepatectomy in assessing the incidence of postoperative hepatic insufficiency. Methods This prospective study included70 patients with hepatocellular carcinoma who underwent partial hepatectomy from November 2016 to May 2017 in the First Central Hospital of Tianjin. The relationship between preoperative and postoperative ICG-R15 and postoperative hepatic insufficiency was analyzed, and the difference between the preoperative and postoperative continuous monitoring of ICG-R15 in assessing the incidence of postoperative hepatic insufficiency was also analyzed. Comparison of categorical data was made by chi-square test. Continuous data were compared using two-independent-samples t test. The area under the receiver operating characteristic curve ( AUC) was used to determine the accuracy of preoperative and postoperative ICG-R15 in assessing the incidence of postoperative hepatic insufficiency. Results Of the 70 patients, 14 ( 20%) had postoperative hepatic insufficiency, and the other patients had good recovery of liver function. The means of ICG-R15 before operation and immediately and at 3 and 5 days after operation were 5. 73% ± 4. 31%, 12. 36% ± 7. 41%, 11. 51% ± 8. 76%, and 9. 60%± 7. 00%, respectively, in the patients with good recovery of liver function, and were 18. 02% ± 13. 48%, 32. 54% ± 18. 67%, 34. 73%± 18. 49%, and 25. 34% ± 11. 49%, respectively, in the patients with postoperative hepatic insufficiency, with significant differences between the two groups of patients ( t = 3. 368, 3. 966, 4. 571, and 4. 901, all P < 0. 05) . The incidence rates of postoperative hepatic insufficiency were 11. 10%, 20. 0%, and 100%, respectively, in patients with ICG-R15 < 10%, 10% < ICG-R15 < 20%, and ICG-R15 >20% preoperatively, were 0, 18. 2%, and 62. 5%, respectively, in patients with ICG-R15 < 10%, 10% < ICG-R15 < 20%, and ICG-R15 > 20% immediately after operation, were 6. 3%, 11. 1%, and 50. 0%, respectively, in patients with ICG-R15 < 10%, 10% 20% at 3 days after operation, and were 5. 3%, 12. 5%, and 62. 5%, respectively, in patients with ICG-R15 < 10%, 10% < ICG-R15 < 20%, and ICG-R15 > 20% at 5 days after operation; the incidence of postoperative hepatic insufficiency increased significantly as ICG-R15 increased ( χ2= 22. 374, 28. 024, 14. 810, and 21. 159, all P < 0. 001) . There were significant differences in the incidence of postoperative hepatic insufficiency between any two of the groups with ICG-R15 < 10%, 10% < ICG-R15< 20%, and ICG-R15 > 20% preoperatively ( all P < 0. 001) , and between any two of the groups with ICG-R15 < 10%, 10% < ICG-R15 < 20%, and ICG-R15 > 20% ( except ICG-R15 < 10% and 10% < ICG-R15 < 20% groups) before operation and at 3 and 5 days after operation ( all P < 0. 05) . The AUCs ( confidence intervals) of ICG-R15 before operation and immediately and at 3 and 5 days after operation were 0. 790 ( 0. 676-0. 878) , 0. 857 ( 0. 752-0. 929) , 0. 855 ( 0. 750-0. 927) , and 0. 870 ( 0. 768-0. 938) , respectively, and the postoperative ICG-R15 values had a significantly larger AUC than the preoperative ICG-R15 ( all P < 0. 05) . Conclusion Postoperative continuous monitoring of ICG-R15 is more accurate than preoperative ICG-R15 in assessing the incidence of hepatic insufficiency among liver cancer patients after partial hepatectomy, and can guide clinicians to provide early clinical intervention.