The 3-60 criteria challenge established predictors of postoperative mortality and enable timely therapeutic intervention after liver resection

Background:To date,definitions of liver dysfunction(LD)after hepatic resection rely on late postoperative time points.Further,the used parameters are markedly influenced by perioperative management.Thus,we aimed to establish a very early postoperative score to predict postoperative mortality.Methods:Liver related parameters were evaluated after liver resection in a retrospective evaluation cohort of 228 colorectal cancer patients with liver metastasis(mCRC)and subsequent validation in a prospective set of 482 consecutive patients from 4 independent institutions undergoing hepatic resection was performed.Results:C-reactive protein(CRP,AUC=0.739,P<0.001)and antithrombinⅢ-activity(ATⅢ,AUC=0.844,P<0.001)on the first postoperative day(POD)were found to be elevated in patients with LD.Cut-off values for CRP at 3 mg/dL and for ATⅢat 60%significantly identified high-risk patients for postoperative LD and mortality(P<0.001)and thus defined the 3-60 criteria on POD1.The 3-60 criteria showed superior sensitivity and specificity compared to established criteria for LD[3-60 criteria:total positive patients:26 patients(70%mortality detected),odds ratio(OR):48.8;International Study Group for Liver Surgery:total positive patients:43(70%mortality detected),OR:23.3;Peak7:total positive patients:9(30%mortality detected),OR:27.8;50-50:total positive patients:9(30%mortality detected),OR:27.8].These results could be validated in a multi-center analysis and ultimately the 3-60 criteria remained an independent predictor of postoperative mortality upon multivariable analysis.Conclusions:The 3-60 criteria on POD1 predict postoperative LD and mortality early after liver resection with a comparable or better accuracy than established criteria,allowing for immediate identification of high-risk patients.