To explore the predictive value of serum creatine kinase (CK) for ischemia-reperfusion injury (IRI) in patients with primary liver cancer (PLC) after hepatectomy.

Clinical data of 93 PLC patients who underwent hepatectomy in Affiliated Nantong Hospital 3 of Nantong University from September 2011 to September 2018 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 78 patients were male and 15 female, aged from 29 to 82 years, with a median age of 60 years. According to whether intermittent Pringle maneuver (IPM) was performed, all patients were divided into the IPM and non-IPM groups.Postoperative changes of serum CK and liver function were observed. Serum CK and liver function parameters were compared between two groups by using t test or Mann-Whitney rank-sum test. The relationship between serum CK and IPM time was analyzed by Spearman rank correlation analysis.

In the IPM group, the median serum CK, ALT, AST and TB levels at postoperative 1 d were 484(354) U/L, 115(136) U/L,94(101) U/L and (30.9±2.2) μmol/L, significantly higher than 75(58) U/L, 98(53) U/L, 78(39) U/L and (22.9±5.6) μmol/L in the non-IPM group (Z=8.292, 2.260, 2.186; t=9.002; P<0.05). In the IPM group, the serum CK, ALT, AST and TB levels at postoperative 3 d were 295(143) U/L, 100(128) U/L, 70(111) U/L and (29.7±2.1) μmol/L, significantly higher than 55(50) U/L, 87(48) U/L, 62(39) U/L and (21.8±5.3) μmol/Lin the non-IPM group (Z=8.229, 2.153, 2.223; t=9.256; P<0.05). In the IPM group, the IPM time was 20(10) min,and the serum CK was positively correlated with IPM time at postoperative 1 and 3 d (r_s=0.896, 0.790; P<0.05).

IPM is a safe and effective approach for hepatic inflow occlusion. Nevertheless, it may lead to hepatic IRI. Postoperative serum CK level can be used as a potential biomarker to predict the degree of IRI injury.