Serum antithrombin III level is well correlated with multiple indicators for assessment of liver function and diagnostic accuracy for predicting postoperative liver failure in hepatocellular carcinoma patients.

Background/Aims: Evaluation of preoperative hepatic reserve is critical to avoid a fatal clinical course such as liver failure. We retrospectively evaluated 158 consecutive hepatocellular carcinoma (HCC) patients who underwent initial hepatectomy. The aim of this study was to determine the correlations of multiple indicators for assessment of liver function before hepatectomy. Furthermore, diagnostic probability for the pathological background and prediction of postoperative liver failure/dysfunction was compared between the antithrombin (AT) III level and indocyanine green retention] rate at 15 minutes (ICGR(15)). Methodology: Between January 2001 and March 2008, 158 HCC patients who underwent initial hepatectomy were enrolled in this study. Spearman's correlation coefficients (r values] were obtained for 15 clinical laboratory tests including ATIII and ICGR(15). Receiver operating characteristic (ROC) curve analysis was used for calculating the probability and predictive ability of the tests. Results: All 158 consecutive HCC patients were eligible for hepatectomy based on the Japanese guideline. ATIII is correlated with 13 of 14 other clinical tests, including albumin, bilirubin, prothrombin time, rapid turnover proteins, HGF, ICGR(15) and others. The diagnostic probabilities to distinguish between normal liver and other pathological backgrounds of ATIII and ICGR(15) were significantly different. The specificity of ATIII to predict postoperative liver failure/dysfunction was higher than that of ICGR(15). Conclusions: The serum ATIII level before hepatectomy is valuable to estimate the pathological background and predict postoperative liver failure/dysfunction. It should be possible to use ATIII as an additional indicator for liver function and substitute for ICGR(15) in the future.