ORIGINAL ARTICLES  CARDIAC PAPERS 

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

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.