Risk Calculator to Predict Perioperative Blood Transfusion in
Liver Resection for Hepatocellular Carcinoma

Prediction for perioperative blood transfusion in liver resection for hepatocellular carcinoma

This prediction tool also known as nomogram is based on data from liver resection for HCC study project participated by several major medical centers in China. American Society of Anesthesiologists(ASA) score, cirrhosis, preoperative hemoglobin level, preoperative international normalized ratio(INR), preoperative total bilirubin level, maximum tumor size, tumor number and planned extent of hepatectomy were incorporated as eight parameters in the model to predict the risk of perioperative blood transfusion in liver resection for hepatocellular carcinoma (HCC). In this way, physicians could facilitate individualized decision making, and ensure the moderation and safety of clinical use of blood.

The model was developed using data from 878 patients at the Eastern Hepatobiliary Surgery Hospital of Shanghai. 691 patients at Tongji Hospital of Wuhan, and 364 patients at two Euromerican hospitals (University of Bologna, Italy; Mount Sinai Hospital of New York, America) were served as the Eastern and Western external validation cohorts, respectively.

The results obtained are for reference only. Patients and caregivers using this tool should discuss the result with the patient’s physician.

Risk Calculator for Perioperative Blood Transfusion in Liver Resection for Hepatocellular Carcinoma Click the underlined variables to get more information. Please fill in all the fields and click the submit.  1) ASA score The ASA physical status classification system is a system for assessing the fitness of patients before surgery. In 1963 the American Society of Anesthesiologists (ASA) adopted the five-category physical status classification system; a sixth category was later added. These are: 1-Healthy person. 2-Mild systemic disease. 3-Severe systemic disease. 4-Severe systemic disease that is a constant threat to life. 5-moribund person who is not expected to survive without the operation. 6-declared brain-dead person whose organs are being removed for donor purposes. * 1, 2, 3 or 4  5) Maximum Tumor Size cm * Range: 0.0~20.0 cm  2) Preoperative International Normalized Ratio (INR) INR derives from the prothrombin time (PT). The result for a PT performed on a normal individual will vary according to the type of analytical system employed. This is due to the variations between different types and batches of manufacturer's tissue factor used in the reagent to perform the test. * Range: 0.80~2.00  6) Cirrhosis Yes No  3) Preoperative Hemoglobin Level Hemoglobin is the iron-containing oxygen-transport metalloprotein in the red blood cells. Hemoglobin in the blood carries oxygen from the lungs to the rest of the body. There it releases the oxygen to permit aerobic respiration to provide energy to power the functions of the organism in the process called metabolism. Testing for the amount of hemoglobin in the blood is used to check for conditions such as anemia, dehydration, and malnutrition. g/dL * Range: 7.0~20.0 g/dL  7) Tumor Number Single Multiple   (≥ 2 nodules)  4) Preoperative Total Bilirubin Level Total bilirubin is composed of conjugated bilirubin and unconjugated bilirubin. It is an important test item in liver and biliary function tests. It can accurately reflect the degree of jaundice and is of great significance for the clinical diagnosis of recessive jaundice. mg/dl * Range: 0.1~20.0 mg/dl  8) Planned Extent of Hepatectomy Major   ( ≥ three segments) Minor   ( < three segments) Probability of Blood Transfusion Risk %