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This prospective study enrolled 151 patients at elevated risk of PHLF (major hepatectomy, thrombocytopenia, or hyperbilirubinemia) and evaluated serum antithrombin III (ATIII) activity, measured preoperatively and on postoperative days (PODs) 1, 2, 3, and 5, as an early predictive marker. PHLF, diagnosed according to the International Study Group of Liver Surgery criteria, occurred in 35 patients (23.2%). ATIII activity was evaluated as raw values and as the percentage change from the preoperative baseline. Raw ATIII activity was significantly lower in the PHLF group at all time points (\n                    <jats:italic>P<\/jats:italic>\n                    \u2009&lt;\u20090.001). The POD 3 ATIII decrease was significantly greater in the PHLF group (36% vs. 29%,\n                    <jats:italic>P<\/jats:italic>\n                    \u2009=\u20090.041). Multivariable logistic regression identified ATIII change from baseline\u2009\u2265\u200930% at POD 3 (odds ratio 3.04,\n                    <jats:italic>P<\/jats:italic>\n                    \u2009=\u20090.021), ALBI grade B (OR 2.77,\n                    <jats:italic>P<\/jats:italic>\n                    \u2009=\u20090.031), and ICG R-15\u2009\u2265\u200915% (OR 3.50,\n                    <jats:italic>P<\/jats:italic>\n                    \u2009=\u20090.034) as independent risk factors for PHLF. The multivariable model demonstrated acceptable discriminative performance (apparent AUC 0.750; bootstrap-corrected AUC 0.730). These findings suggest that early postoperative decline in ATIII activity could serve as an early biomarker for identifying patients at increased risk of PHLF, potentially enabling timely intervention.\n                  <\/jats:p>","DOI":"10.1038\/s41598-026-53370-1","type":"journal-article","created":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T05:24:15Z","timestamp":1779427455000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Serum antithrombin III as an early predictive marker for post-hepatectomy liver failure: a prospective cohort study"],"prefix":"10.1038","volume":"16","author":[{"given":"Hye-Sung","family":"Jo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sehyeon","family":"Yu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Su-Min","family":"Jeon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoo-Jin","family":"Choi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Young-Dong","family":"Yu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dong-Sik","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,22]]},"reference":[{"key":"53370_CR1","doi-asserted-by":"publisher","first-page":"631","DOI":"10.1016\/j.jhep.2025.10.020","volume":"84","author":"M Reig","year":"2026","unstructured":"Reig, M. et al. 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The funder was not involved in the study design, data collection, analysis, interpretation of data, the writing of this article, or the decision to submit it for publication. All authors declare no other competing interests.","order":1,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. The study was conducted in accordance with the Declaration of Helsinki. The study was approved by the ethics review board of Korea University Anam Hospital (No. 2023AN0252). Written informed consent was obtained from all participants. All tables and figures in this study contain original content that has not been published previously.","order":2,"name":"Ethics","label":"Ethics approval","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"23307"}}