The Clinical Research Of Albumin-bilirubin Score For Posthepatectomy Liver Failure Predictors In Primary Liver Cancer

Objection:1.To investigate the perioperative risk factors for posthepatectomy liver failure(PHLF)in patients with hepatocellular carcinoma(HCC).2.To study the power of the Albumin-bilirubin score(ALBI)for PHLF.Methods:The retrospective cohort study was conducted.The clinical data of HCC patients who were admitted into the Shengjing Hospital of China Medical University between September 2013 and September 2018 were collected.Patients were divided into a liver failure group(n=53)and a no liver failure group(n=269)according to the International Hepatic Surgery Group’s liver failure criteria for PHLF.Logistic regression was used to analyze the risk factors for PHLF.The receiver operating characteristic(ROC)curve was used to analyze the predictive power of the ALBI score and the Child-Pugh score for PHLF.Result:1.The incidence of PHLF was 16.5%(53/322).Significant differences were observed between the two groups in peritoneal effusion,liver fibrosis,ICGR15,Child-Pugh,ALBI,albumin(Alb),alanine aminotransferase(ALT),glutamic oxaloacetic transaminase(AST),cholinesterase(ChE),prealbumin(PA),total bilirubin(TBil),prothrombintime(PT),preoperative platelet,postoperative platelet,the ratio of AST and PLT(APRI),Fib-4 index,by TACE before the surgery,intraoperative bleeding amount and transfused at operation(P<0.05).2.For avoiding multicollinearity,factors associated with APRI score(AST and preoperative platelets)and FIB-4 score(age,AST,ALT,and preoperative platelets)were excluded in the multivariate analysis,and Child-Pugh score and ALBI score were respectively analyzed using the logistic regression model.Excluding TBil,Alb,PT and peritoneal effusion,logistic regression model of Child-Pugh score showed that Child-Pugh score,intraoperative bleeding amount,ICG R15 and liver fibrosis were independent factors affecting PHLF of HCC patients(OR=2.244,1.001,1.146,1.193;95%CI:1.281-3.392,1.000-1.002,.067-1.231,1.205-3.107,P<0.05).Excluding TBil and Alb,logistic regression model of ALBI score showed that intraoperative bleeding amount,ICG R15,liver fibrosis,peritoneal effusion and ALBI score were independent factors affecting PHLF of HCC patients(OR=1.001,1.128,1.751,.634,10.886;95%CI:1.000-1.002,1.049-1.212,1.077-2.847,1.727-12.437,2.035-58.226,P<0.05).3.ROC analysis of Child-Pugh and ALBI scores predicting PHLF showed that area under the ROC was respectively 0.621(95%CI:0.531-0.712)in the Child-Pugh score and 0.729(95%CI:0.645-0.812)in the ALBI score,with a statistically significant difference(Z=1.715 P=0.04).The best critical value,sensitivity and specificity of PHLF that were predicted by ALBI score were-2.74,71.7% and 71.4%,respectively.Further analysis showed that area under the ROC was respectively 0.65(95%CI:0.549-0.751)in Child-Pugh score and0.774(95%CI:0.687-0.861)in ALBI score,excluding factors of extensive liver resection,with a statistically significant difference(Z=1.841 P=0.03).Conclusion:1.Child-Pugh score,ALBI score,intraoperative bleeding amount,ICG R15 and liver fibrosis,peritoneal effusion were independent factors affecting PHLF of HCC patients.2.ALBI score is an effective predictor of PHLF in HCC patients,and the prognostic power of the ALBI score was greater than that of the Child-Pugh score in predicting PHLF.