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THE JOURNAL OF CARDIOVASCULAR SURGERY

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The Journal of Cardiovascular Surgery 1999 December;40(6):817-23

Copyright © 2000 EDIZIONI MINERVA MEDICA

lingua: Inglese

Esti­ma­tion of func­tional ­liver ­reserve in ­patients ­before car­diac sur­gery using anti­py­rine ­plasma clear­ance ­test

Takeda M., Furuse A., Kawauchi M., Kotsuka Y., Takamoto S.

From the Depart­ment of Car­di­oth­o­racic Sur­gery Uni­ver­sity of ­Tokyo, ­Japan


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Back­ground. Hyper­bil­i­ru­bi­nemia is not ­uncommon and is some­times ­fatal ­after val­vular sur­gery. One impor­tant ­cause of it is a ­poor func­tional ­liver ­reserve, how­ever, con­ven­tional ­tests ­reflect ­hepatic ­blood ­flow and do not ­offer pre­cise eval­u­a­tion of the ­pure func­tional ­liver ­reserve. Anti­py­rine has par­tic­ular phar­mac­o­log­ical prop­er­ties, and its ­plasma clear­ance rep­re­sents quan­ti­ta­tively the func­tional ­capacity of the ­liver. In ­this ­study, we meas­ured anti­py­rine ­plasma clear­ance in car­diac sur­gical ­patients and eval­u­ated the fea­sibility of ­using ­this param­eter as a pre­dictor of the ­risk of post­op­er­a­tive hyper­bil­i­ru­bi­nemia.
­Methods. The ­plasma clear­ance of anti­py­rine was meas­ured pre­op­er­a­tively in 40 car­diac ­patients under­going ­mitral and/or tri­cuspid val­vular sur­gery and its rela­tions ­with hemo­dy­namics or post­op­er­a­tive ­course were ­studied.
­Results. Anti­py­rine clear­ance in pre­op­er­a­tive ­patients was 0.365±0.175 (­mean ±SD) ml/min/kg, ­lower ­than the ­normal ­range (0.405±0.04 ml/min/kg), and ­showed no cor­re­la­tion ­with car­diac ­index, ­while the ­plasma dis­ap­pear­ance ­rate of indoc­ya­nine ­green ­depended on the car­diac ­index. The max­imum post­op­er­a­tive ­total bilir­ubin ­level ­showed sig­nif­i­cant cor­re­la­tion ­with anti­py­rine clear­ance (r=-0.699); ­this cor­re­la­tion coef­fi­cient was ­greater ­than ­that ­with indoc­ya­nine ­green (-0.477). The cor­re­la­tion was ­more prom­i­nent in ­patients ­with car­diac dys­func­tion. Fur­ther­more, anti­py­rine clear­ance ­showed sig­nif­i­cant pre­dict­ability of the dura­tion of ICU ­stay.
Con­clu­sions. Anti­py­rine clear­ance pro­vides a pre­cise esti­mate of func­tional ­liver ­reserve ­which is inde­pen­dent of hemo­dy­namics and pre­dicts the ­risk of post­op­er­a­tive hyper­bil­i­ru­bi­nemia in pre­op­er­a­tive car­diac ­patients.

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