Combination Of ALBI And APRI To Predict Post-Hepatectomy Liver Failure After Liver Resection For HBV-Related HCC Patients

Figures & data

Table 1 Baseline Characteristics Of The Included 1055 Patients With HBV-Related HCC

Variables	Patient Population (n = 1055)
Age (≥60/<60 yrs)	162 (15.4%)/893 (84.6%)
Sex (male/female)	921 (87.3%)/134 (12.7%)
Total bilirubin (μmol/L)	12.4 (2.7 ~66.8)
Albumin (g/L)	40.9 (24.9 ~54.4)
Aspartate aminotransferase (U/L)	42 (14 ~459)
Platelet count (10^9/L)	172 (12 ~668)
Prothrombin time (sec)	12.9 (9.4 ~22.4)
AFP (≥400/<400 ng/mL)	432 (40.9%)/623 (59.1%)
CSPH	219 (20.8%)
Ascites	183 (17.3%)
C-P grade (A/B/C)	1008 (95.5%)/47 (4.5%)/0 (0%)
C-P score	5 (5–9)
ALBI score	−2.77 (−3.91 ~ −1.14)
APRI score	0.64 (0.11 ~23.75)
Tumor size (cm)	6.0 (1.0 ~25.0)
Tumor number (≥3/<3)	128 (12.1%)/927 (87.9%)
Extent of resection (major/minor)	220 (20.9%)/835 (79.1%)
Blood loss (>400/≤400 mL) (n)	338 (32.0%)/717 (68.0%)

Abbreviations: AFP, alpha fetoprotein; CSPH, clinically significant portal hypertension; C-P, Child-Pugh; ALBI, albumin–bilirubin; APRI, aspartate aminotransferase to platelet ratio index; HBV, hepatitis B virus; HCC, hepatocellular carcinoma.

Table 2 Univariable And Multivariable Analyses For PHLF

Variable	Univariate Analysis		Multivariate Analysis
	OR (95% CI)	P Value	OR (95% CI)	P Value
Age (≥60 years)	1.450 (0.934–2.252)	0.098	1.054 (0.902–2.059)	0.118
Sex (female)	0.345 (0.165–0.721)	0.005	0.332 (0.149–0.737)	0.007
AFP (≥400 ng/mL)	1.005 (0.708–1.427)	0.976	–	–
CSPH	5.208 (3.614–7.505)	< 0.001	3.573 (2.298–5.556)	< 0.001
C-P score	2.102 (1.647–2.681)	< 0.001	0.940 (0.665–1.329)	0.726
ALBI score	8.501 (5.244–13.781)	< 0.001	5.280 (2.763–10.086)	< 0.001
APRI score	2.156 (1.777–2.617)	< 0.001	1.583 (1.275–1.964)	< 0.001
Tumor size (cm)	1.069 (1.025–1.114)	0.002	0.989 (0.934–1.047)	0.696
Tumor number (≥3)	1.438 (0.889–2.327)	0.139	-	-
Major liver resection	2.566 (1.769–3.722)	< 0.001	2.986 (1.845–4.835)	< 0.001
Blood loss (>400 mL)	3.423 (2.404–4.874)	< 0.001	2.294 (1.503–3.502)	< 0.001

Abbreviations: AFP, alpha fetoprotein; CSPH, clinically significant portal hypertension; C-P, Child-Pugh; ALBI, albumin–bilirubin; APRI, aspartate aminotransferase to platelet ratio index; PHLF, post- hepatectomy liver failure.

Table 3 Incidence And Severity Of ALBI, APRI And Combination ALBI-APRI Scores For Predicting PHLF

	ALBI Score			APRI Score			ALBI-APRI Score
≤ −2.77 (n=537)	> −2.77 (n=518)	P Value	≤ 0.85 (n=700)	> 0.85 (n=355)	P Value	≤ −13.10 (n=595)	> −13.10 (n=460)	P Value
PHLF	33 (6.1%)	118 (22.8%)	< 0.001	58 (8.3%)	93 (26.2%)	< 0.001	33 (5.5%)	118 (25.7%)	< 0.001
PHLF A	17 (3.2%)	37 (7.1%)	< 0.001	22 (3.1%)	32 (9.0%)	< 0.001	15 (2.5%)	39 (8.5%)	< 0.001
PHLF B	16 (3.0%)	68 (13.1%)	< 0.001	31 (4.4%)	53 (14.9%)	< 0.001	17 (2.9%)	67 (14.6%)	< 0.001
PHLF C	0 (0%)	13 (2.5%)	< 0.001	5 (0.7%)	8 (2.3%)	< 0.001	1 (0.2%)	12 (2.6%)	< 0.001

Abbreviations: ALBI, albumin–bilirubin; APRI, aspartate aminotransferase to platelet ratio index; ALBI-APRI, combination of ALBI and APRI; PHLF, post-hepatectomy liver failure.

Figure 1 (A) ROC curves for C-P grade, ALBI and APRI scores for predicting PHLF; (B) ROC curve for ALBI and APRI, combination of ALBI and APRI scores for predicting PHLF.

Abbreviations: PHLF, post-hepatectomy liver failure; C-P, Child-Pugh; ALBI, albumin–bilirubin; APRI, aminotransferase-platelet ratio index; ALBI-APRI, combination of ALBI and APRI.

Figure 2 Correlation of incidence and severity of PHLF and (A) ALBI score; (B) APRI score; (C) ALBI-APRI score.

Abbreviations: PHLF, post-hepatectomy liver failure; ALBI, albumin–bilirubin; APRI, aminotransferase-platelet ratio index; ALBI-APRI, combination of ALBI and APRI.

Figure 3 ROC curves for ALBI, APRI, and ALBI-APRI scores for predicting the risk of PHLF for subjects who underwent minor resection.

Abbreviations: PHLF, post-hepatectomy liver failure; ALBI, albumin–bilirubin; APRI, aminotransferase-platelet ratio index; ALBI-APRI, combination of ALBI and APRI.