ABSTRACT
Background and Objectives: Critically ill surgical patients are susceptible to various postoperative complications, including acute kidney injury (AKI) and multiorgan distress syndrome (MODS). These complications intensify patient suffering and significantly increase morbidity and mortality rates. This study aimed to identify the biomarkers for predicting AKI and MODS in critically ill surgical patients. Materials and Methods: We prospectively enrolled critically ill surgical patients admitted to the intensive care unit via the emergency department between July 2022 and July 2023. A total of 83 patients were recruited, and their data were used to analyze MODS. Three patients who showed decreased creatinine clearance at the initial presentation were excluded from the analysis for AKI. Patient characteristics and laboratory parameters including white blood cell (WBC) count, neutrophil count, delta neutrophil index, urine and serum ß2-microglobulin, and urine serum mitochondrial DNA copy number (mtDNAcn) were analyzed to determine the reliable biomarker to predict AKI and MODS. Results: The following parameters were independently correlated with MODS: systolic blood pressure (SBP), initial neutrophil count, and platelet count, according to a logistic regression model. The optimal cut-off values for SBP, initial neutrophil count, and platelet count were 113 mmHg (sensitivity 66.7%; specificity 73.9%), 8.65 (X3) (109/L) (sensitivity 72.2%; specificity 64.6%), and 195.0 (X3) (109/L) (sensitivity 66.7%; specificity 81.5%), respectively. According to the logistic regression model, diastolic blood pressure (DBP) and initial urine mtDNAcn were independently correlated with AKI. The optimal cut-off value for DBP and initial urine mtDNAcn were 68.5 mmHg (sensitivity 61.1%; specificity 79.5%) and 1225.6 copies/µL (sensitivity 55.6%; specificity 95.5%), respectively. Conclusions: SBP, initial neutrophil count, and platelet count were independent predictors of MODS in critically ill patients undergoing surgery. DBP and initial urine mtDNAcn levels were independent predictors of AKI in critically ill surgical patients. Large-scale multicenter prospective studies are needed to confirm our results.
Subject(s)
Acute Kidney Injury , Critical Illness , Humans , Prospective Studies , Biomarkers , Acute Kidney Injury/diagnosis , Acute Kidney Injury/etiology , Intensive Care UnitsABSTRACT
BACKGROUND: There is no consensus on the safe resection margin in patients with hepatocellular carcinoma. Surgeons decide the extent of resection according to residual liver function and tumor location. We investigated the influence of resection margin on early recurrence with respect to gross tumor type and expression of cytokeratin 19 (CK19). METHODS: We divided the patients into two groups based on the classification of The Korean Liver Cancer Study group as follows: group 1 included expanding and vaguely nodular types whereas group 2 included nodular with perinodular extension, multinodular confluent, and infiltrative types. We classified the resection margin as narrow (0.1-0.9 cm) or wide (greater than 1 cm). We compared clinicopathological features and CK19 positivity between the groups. RESULTS: Group 2 had a higher prevalence of gross portal vein invasion, microscopic portal vein invasion, microvessel invasion, satellite nodules, intrahepatic metastasis, multicentric occurrence, and positivity for CK19. Group 1 showed no difference in recurrence according to the resection margin; however, group 2 showed a higher recurrence rate in patients with a narrow resection margin compared with those with a wide resection margin (P = 0.047). Patients in group 2 with CK19 positivity showed a higher prevalence of microvessel invasion than those without CK19 (P = 0.026). CONCLUSIONS: Although our study has the limitation of a small number of cases, the data suggest that patients with hepatocellular carcinoma of expanding and vaguely nodular gross types may safely undergo surgical resection with a narrow resection margin and a low risk of early recurrence.
