Total bile acid is a useful tool for evaluating the risk of portal hypertension in patients with hepatocellular carcinoma who have undergone hepatectomy.

OBJECTIVE

Evaluating portal hypertension is crucial for patients with hepatocellular carcinoma (HCC) who are candidates for liver resection. Total bile acid (TBA) is an easily accessible marker, but its potential as a non-invasive indicator of portal hypertension in patients with HCC is yet to be fully established.

METHODS

This study included patients with HCC classified as Child-Pugh stage A who underwent liver resection at a referral hospital. Elevated TBA levels were defined as serum TBA >10 μmol/L, while normal levels were ≤10 μmol/L.

RESULTS

A total of 167 patients with HCC with Child-Pugh Class A who underwent liver resection were analyzed. The cohort was divided into normal (n = 125) and elevated TBA groups (n = 42). Compared to patients with normal TBA levels, those with elevated TBA had significantly higher 15-min indocyanine green retention rates (ICG R15) (p <0.001), higher Child-Pugh scores (p <0.001), more advanced Laennec fibrosis stages (p = 0.039), and a higher incidence of esophageal gastric varices (p = 0.001) and post-hepatectomy liver failure (p = 0.001). Multivariate analysis showed that elevated TBA was independently associated with ICG R15 (odds ratio [OR] = 1.150, 95% confidence interval [CI] = 1.055-1.254, p = 0.002), fibrosis stages (OR = 1.973, 95% CI = 1.026-3.796, p = 0.042), and Child-Pugh score (OR = 4.121, 95% CI = 1.367-12.424, p = 0.012).

CONCLUSION

Elevated TBA levels in patients with HCC with Child-Pugh class A are significantly associated with portal hypertension and a higher incidence of post-hepatectomy liver failure.