Analysis Of Related Factors Of Post-hepatectomy Liver Failure And Albumin-bilirubin Score Versus Child-Pugh Score As Predictors Of Post-hepatectomy Liver Failure

ObiectivesThis study aimed to analyze the related factors of post-hepatectomy liver failure and compare the discriminatory power of the Albumin-bilirubin score(ALBI)and Child-Pugh score to predict post-hepatectomy liver failure in patients with hepatocellular carcinoma after curative liver resection.MethodsClinical data of hepatocellular carcinoma patients who received curative hepatectomy at Nanfang Hospital,Southern Medical University from June 2011 to December 2016 were reviewed.Inclusion criteria:(1)The age of the patients was between 18 to 80 years.(2)The liver cancer was received radical resection of R0 standards.(3)The histological type was hepatocellular carcinoma,which was confirmed by postoperative pathology.Exclusion criteria:(1)The hepatocellular carcinoma violate portal vein and its first branch nor the common hepatic duct and its first grade branch nor hepatic vein trunk nor inferior vena cava.Or the presence of extrahepatic metastases were found.(2)Biliary obstruction existed in the patient or the surgery combined with exploration and reconstruction of the bile duct.(3)The surgery combined with splenectomy or splenic artery ligation.(4)The patient combined with heart,lung,kidney and other organs of major diseases before surgery.(5)Other histological type was confirmed by postoperative pathology.(6)The patients died in 90 days after surgery because of the causes except for post-hepatectomy liver failure;.(7)Lack of clinical data.In this study,the definition and diagnostic criteria of post-hepatectomy liver failure were proposed by International Liver Group of Liver Surgery(ISGLS)in 2011.Related factors of post-hepatectomy liver failure were identified through logistic regression.The area under the receiver operating characteristic(ROC)curve was calculated to measure the ability of ALBI and Child-Pugh scores as predictors of post-hepatectomy liver failure.ResultsA total of 1013 patients were enrolled.The incidence of post-hepatectomy liver failure is 17.7%(179/1013).Child-Pugh score,ALBI score,male,PLT<100 ×109/1,liver cirrhosis,pringle maneuver>15 minutes,pringle maneuver>30 minutes,major liver resection were identified as independent predictors of post-hepatectomy liver failure in multivariable analysis.The incidence of post-hepatectomy liver failure in patients with Child-Pugh grade A was significantly lower than those with Child-Pugh grade B(16.4%,158/963 vs 42%,21/50,P<0.001).The incidence of post-hepatectomy liver failure in patients with AIBI 1,2 and 3 was 9.9%(50/504),24.8%(124/501)and 62.5%(5/8)(P<0.001),indicating that the incidence of post-hepatectomy liver failure increased significantly with increasing ALBI grade.Moreover,the ALBI score classified patients of Child-Pugh grade A into ALBI 1-A and ALBI 2-A subgroups.The incidence of post-hepatectomy liver failure in patients with ALBI 1-A was significantly lower than those with ALBI 2-A(9.9%,50/504 vs 23.5%,108/459,P<0.001).The area under ROC curve of ALBI score for predicting post-hepatectomy liver failure was greater than that of Child-Pugh score(0.705 vs 0.630;P<0.001).ConclusionsChild-Pugh score,ALBI score,male,PLT<100 ×109/1,liver cirrhosis,pringle maneuver>15 minutes,pringle maneuver>30 minutes,major liver resection were identified as independent predictors of post-hepatectomy liver failure in multivariable analysis.The prognostic power of ALBI score is greater than Child-Pugh score in predicting post-hepatectomy liver failure.Even in the patients with Child-Pugh grade A,the ALBI score is more sensitive to identify patients with high risk of post-hepatectomy liver failure.The ALBI score is a useful tool to predict post-hepatectomy liver failure for hepatocellular carcinoma patients accepting hepatectomy.