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A novel online calculator based on noninvasive markers (ALBI and APRI) for predicting post-hepatectomy liver failure in patients with hepatocellular carcinoma - 14/10/20

Doi : 10.1016/j.clinre.2020.09.001 
Jin-Yu Shi a, 1, Li-Yang Sun b, c, 1, Bing Quan b, c, 1, Hao Xing b, 1, Chao Li b, 1, Lei Liang b, 1, Timothy M. Pawlik d, Ya-Hao Zhou e, Hong Wang f, Wei-Min Gu g, Ting-Hao Chen h, Wan Yee Lau b, i, Feng Shen b, Nan-Ya Wang a, , Tian Yang b,
a The Cancer Center, the First Hospital of Jilin University, Changchun, China 
b Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Naval Medical University), Shanghai, China 
c Department of Clinical Medicine, Second Military Medical University (Naval Medical University), Shanghai, China 
d Department of Surgery, Ohio State University, Wexner Medical Center, Columbus, OH, United States 
e Department of Hepatobiliary Surgery, Pu’er People’s Hospital, Yunnan, China 
f Department of General Surgery, Liuyang People’s Hospital, Hunan, China 
g The First Department of General Surgery, The Fourth Hospital of Harbin, Heilongjiang, China 
h Department of General Surgery, Ziyang First People’s Hospital, Sichuan, China 
i Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, N.T., Hong Kong SAR, China 

Corresponding author at: Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Navy Medical University), No. 225, Changhai Road, Shanghai 200438, ChinaDepartment of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Navy Medical University)No. 225, Changhai RoadShanghai200438China⁎⁎Corresponding author at: The Cancer Center, the First Hospital of Jilin University, No. 71, Xinmin Street, Changchun, Jilin, ChinaThe Cancer Center, the First Hospital of Jilin UniversityNo. 71, Xinmin StreetChangchunJilinChina
Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Wednesday 14 October 2020

Highlights

Post-hepatectomy liver failure (PHLF) is a devastating complication.
Multivariable analysis identified high ALBI and APRI grades as independent risks of PHLF in both pre- and postoperative models.
The AUCs for the pre- and postoperative models were higher than APRI, ALBI, MELD and Child-Pugh scores in predicting PHLF.
Two online calculators that combined ALBI and APRI were proposed as useful tools for predicting the occurrence of PHLF.

Le texte complet de cet article est disponible en PDF.

Abstract

Background and aim

Post-hepatectomy liver failure (PHLF) remains the primary cause of in-hospital mortality after hepatectomy. Identifying predictors of PHLF is important to improve surgical safety. We sought to identify the predictive accuracy of two noninvasive markers, albumin-bilirubin (ALBI) and aspartate aminotransferase to platelet count ratio index (APRI), to predict PHLF among patients with hepatocellular carcinoma (HCC), and to build up an online prediction calculator.

Methods

Patients who underwent resection for HCC between 2013 and 2016 at 6 Chinese hospitals were retrospectively analyzed. The independent predictors of PHLF were identified using univariate and multivariate analyses; derivative data were used to construct preoperative and postoperative nomogram models. Receiver operating characteristic (ROC) curves for the two predictive models, and ALBI, APRI, Child-Pugh, model for end-stage liver disease (MELD) scores were compared relative to predictive accuracy for PHLF.

Results

Among the 767 patients in the analytic cohort, 102 (13.3%) experienced PHLF. Multivariable logistic regression analysis identified high ALBI grade (>-2.6) and high APRI grade (>1.5) as independent risk factors associated with PHLF in both the preoperative and postoperative models. Two nomogram predictive models and corresponding web-based calculators were subsequently constructed. The areas under the ROC curves for the postoperative and preoperative models, APRI, ALBI, MELD and Child-Pugh scores in predicting PHLF were 0.844, 0.789, 0.626, 0.609, 0.569, and 0.560, respectively.

Conclusions

ALBI and APRI demonstrated more accurate ability to predict PHLF than Child-Pugh and MELD. Two online calculators that combined ALBI and APRI were proposed as useful preoperative and postoperative tools for individually predicting the occurrence of PHLF among patients with HCC.

Le texte complet de cet article est disponible en PDF.

Abbreviations : HCC, PHLF, ALBI, APRI, MELD, ROC, AUC, ALT, AST, NR, ASA, RLV, CSPH, BMI, TB, CT, MRI, OR, CI

Keywords : Hepatocellular carcinoma, Liver resection, Post-hepatectomy liver failure, Albumin-bilirubin, Aspartate transaminase to platelet ratio index, Prediction


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