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A Predictor of Postoperative Morbidity and Mortality

Richard H. Pearl, MD; George H. A. Clowes, Jr, MD; Silvano Bosari, MD; William V. McDermott, MD; James O. Menzoian, MD; Wendy Love, MD; Roger L. Jenkins, MD

Arch Surg. 1987;122(4):468-473.

Abstract
• The central plasma clearance rate of amino acids (CPCR-AA), the ratio of peripheral amino acid entry rate into blood plasma to arterial amino acid concentration, was measured preoperatively in 149 noninfected cirrhotic patients. In 50 survivors of shunting or general surgical procedures, the mean (±SEM) CPCR-AA was 201±17 mL/m² min; in 39 subsequent deaths, the mean ratio was 87±14 mL/m² min. Comparing Child's classification with CPCR-AA reveals the following values: class A (mortality, two of ten patients) survivors, 152±23 mL/m²/min; class A deaths, 96±54 mL m² min; class C (mortality, 13 of 19 patients) survivors, 214±47 mL/m²/min; class C deaths, 101 ±13 mL m² min. The preoperative CPCR-AA of 46 patients receiving liver transplants was 91 ± 9 mL/m₂/min; 69% of these patients survived. Preoperative CPCR-AA values correlated significantly with rates of hepatic protein synthesis in incubated liver slices obtained by biopsy at operation in 22 patients. Thus, CPCR-AA determination is a true liver function test, valuable in predicting surgical mortality and selecting transplantation or other operations for cirrhotic patients.

(Arch Surg 1987;122:468-473)

Author Affiliations
From the Department of Surgery, Harvard Medical School at New England Deaconess Hospital, Boston (Drs Pearl, Clowes, Bosari, McDermott, Love, and Jenkins); and Boston University School of Medicine at University Hospital and Boston City Hospital (Drs Clowes and Menzoian).

Footnotes
Accepted for publication Dec 16, 1986.

Read before the 67th Annual Meeting of the New England Surgical Society, Dixville Notch, NH, Sept 28, 1986.

Reprint requests to New England Deaconess Hospital/Harvard Surgical Service, Cancer Research Institute, 194 Pilgrim Rd, Boston, MA 02215 (Dr Clowes).

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