A simple, noninvasively determined index predicting hepatic failure following liver resection for hepatocellular carcinoma

Abstract

Background A novel index, the serum aspartate aminotransferase activity/platelet count ratio index (APRI), has been identified as a biochemical surrogate for histological fibrogenesis and fibrosis in cirrhosis. We evaluated the ability of preoperative APRI to predict hepatic failure following liver resection for hepatocellular carcinoma. Methods Potential preoperative risk factors for postoperative hepatic failure (hepatic coma with hyperbilirubinemia, four patients; intractable pleural effusion or ascites, 30 patients; and variceal bleeding, one patient) as well as APRI were evaluated in 366 patients undergoing liver resection for hepatocellular carcinoma. Prognostic significance was determined by univariate and multivariate analyses. Results Hepatic failure developed postoperatively in 30 patients, causing death in four. APRI correlated with histological intensity of hepatitis activity and degree of hepatic fibrosis, and was significantly higher in patients who developed postoperative hepatic failure than in others without failure. Risk of postoperative hepatic failure increased as the serum albumin concentration and platelet count decreased and as indocyanine green retention rate at 15 min, aspartate and alanine aminotransferase activities, and APRI increased. Only APRI was an independent preoperative factor on multivariate analysis. Of the four patients who died of postoperative hepatic failure, three had an APRI of at least 10. Conclusions Preoperative APRI independently predicted hepatic failure following liver resection for hepatocellular carcinoma. Patients with an APRI of 10 or more have a high risk of postoperative hepatic failure.

Preoperative aspartate aminotransferase-to-platelet ratio index (APRI) is a predictor on postoperative outcomes of hepatocellular carcinoma

“…[8,22] Ichikawa et al [23] reported that preoperative APRI independently predicted hepatic failure following liver resection for HCC, and patients with an APRI of 10 or more have a high risk of postoperative hepatic failure. In the present study, we identified APRI was an independent risk factor for overall postoperative complications by univariate and multivariate analyses.…”

Albumin-Indocyanine Green Evaluation Grading System Predicts Post-Hepatectomy Liver Failure for Biliary Tract Cancer

“…The FIB4 index was calculated using the following formula: (age [years] × AST [U/L])/(Platelet Count [10 9 /L]) × √ALT [U/L] [16]. According to previous reports, we set the cutoff values of the ALBI score, APRI, and FIB4 index at –2.60, 1.00, and 2.67, respectively [7, 14, 17]. …”

Surgery and Hepatocellular Carcinoma

“…Similar to the CPT score, the MELD score works well for patients with marginal liver function, but it fails to differentiate the surgical risk in those patients in which HCC is more suitable for resection. While the APRI score is promising, there are few reports of discussing APRI score [4]. Similar to the CPT and MELD scores, the APRI score seems adequate for patients with advanced liver disease, i.e.…”