A Retrospective Pilot Study To Examine The Potential Of Aspartate Aminotransferase To Alanine Aminotransferase Ratio As A Predictor Of Post-operative Acute Kidney Injury In Patients With Hepatocellular Carcinoma

Background and ObjectivesThe aspartate aminotransferase(AST)/ alanine aminotransferase(ALT)ratio(AST/ALT)is an independent predictor of hepatic disease.The aim of this study is to evaluate the association between pre-operative AST/ALT and post-operative acute kidney injury(AKI)in hepatocellular carcinoma(HCC)patients.MethodsA total of 422 hepatitis B-or C-virus associated HCC patients,who underwent hepatectomy between September 2012 and April 2018,were enrolled this retrospective study.From all patients,AST and ALT parameters were collected and the AST/ALT ratio was calculated.For diagnostic criteria of post-operative AKI,the Kidney Disease Improving Global Outcomes(KDIGO)criteria guidelines were used.(A Cr increase of ≥0.3 mg/dl(26.5 mmol/l)above baseline within 48 hours after surgery or an increase of ≥1.5-fold above baseline within 7 days after surgery).ResultsIn 48 patients(11.4%),post-operative AKI was confirmed.In patients with post-operative AKI,the mean pre-operative serum AST/ALT was significantly higher when compared to patients without post-operative AKI.After multivariate logistic regression analysis,AST/ALT,hemoglobin,age,hypertension,Child-Turcotte-Pugh classification and the Milan criteria were all confirmed as predictive factors of postsurgical AKI.We found that an AST/ALT of 1.29 was the best cutoff point for predicting post-operative AKI.After matching the propensity score,AST/ALT ≥1.29 was still confirmed as an independent predictor of post-operative AKI by multivariate analysis.ConclusionPre-operative elevated serum AST/ALT may be a potential independent predictor of post-operative AKI in HCC patients who have undergone hepatectomy.