Assessment of Liver Function for Evaluation of Short- and Long-Term Outcomes in Type B Aortic Dissection Patients Undergoing Thoracic Endovascular Aortic Repair

Abstract

Background and Aims: Patients with decreased liver function suffer from poor outcomes when undergoing procedures. We aimed to explore the impact of liver fibrosis identified by aspartate transaminase-to-platelet ratio index (APRI) and poor liver functional reserve assessed by a model of end-stage liver disease (MELD) and albumin–bilirubin(ALBI) score on the prognosis of patients with type B aortic dissection (TBAD) undergoing thoracic endovascular aortic repair (TEVAR).Methods: A retrospective analysis of a prospectively maintained database from 2010 to 2017 was performed. APRI > 0.5 was used to identify those with significant liver fibrosis. Logistic and Cox regression analyses were performed to investigate the association between liver fibrosis, MELD, and ALBI with adverse events.Results: TEVAR was performed on 812 TBAD patients including 35 with liver fibrosis and 777 without. Twenty-four (3.0%) patients deceased during hospitalization and 69 (8.8%) patients died after a median 48.2 months follow-up. Multivariable analysis revealed that liver fibrosis, MELD, and ALBI were independently associated with in-hospital [fibrosis: odds ratio (OR) 23.73, 95% confidence interval (CI) 8.89–63.33, P < 0.001; MELD: OR 1.08, 95% CI 1.03–1.14, P = 0.003; ALBI: OR 4.45; 95% CI 1.56–12.67, P = 0.005] and follow-up mortality [fibrosis: hazard ratio (HR) 4.69, 95% CI 1.93–11.42, P = 0.001; MELD: HR 1.07, 95% CI 1.04–1.10, P < 0.001; ALBI: HR 2.88, 95% CI 1.53–5.43, P = 0.001]. The association was further corroborated by a subgroup analysis.Conclusion: Liver fibrosis and poor liver functional reserve could significantly increase the morbidity and mortality after TEVAR. APRI, MELD, and ALBI should be calculated and routinely used for preoperative risk stratification. Strict preoperative preparation and elaborate postoperative care are necessary to improve these patients' prognosis.

Analysis of the albumin‐bilirubin score as an indicator of improved liver function among hepatitis C virus patients with sustained viral response after direct‐acting antiviral therapy

“…ALBI was shown as a prognostic factor in patients with primary biliary cholangitis, 15 HBV‐related acute‐on‐chronic liver failure, 16 and HBV cirrhosis, 17 suggesting its capacity to assess liver dysfunction in the absence of liver cancer. Finally, ALBI has been used as an indicator of deterioration in liver function comparable to MELD, being a good predictor of mortality and postoperative complications 18–20 . Even more importantly, there is no minimum score for ALBI as there is for CTP, and this lack of “floor effect” may provide ALBI with a better ability to discriminate liver function between patients with a fairly preserved liver function.…”

“…Finally, ALBI has been used as an indicator of deterioration in liver function comparable to MELD, being a good predictor of mortality and postoperative complications. 18 , 19 , 20 Even more importantly, there is no minimum score for ALBI as there is for CTP, and this lack of “floor effect” may provide ALBI with a better ability to discriminate liver function between patients with a fairly preserved liver function. In other words, if ALBI echoes accurately liver function, it should be able to capture slight improvements in function when liver damage subsides after therapy in conditions where there is little liver dysfunction.…”

The ALBI score: From liver function in patients with HCC to a general measure of liver function

“…J o u r n a l P r e -p r o o f 10[145] ALBI proved superior to well-established scores such as SOFA, SAPS-II, APACHE-II, Ranson and Glasgow. In each of these instances authors have attempted to explain their results in terms of liver dysfunction associated with the particular condition described.…”

“… Liu et al. 145 Retrospective 812 Aortic dissection ALBI score as well as MELD score and APRI was associated with in-hospital and follow-up mortality in patients with type B aortic dissection treated with thoracic endovascular aortic repair. ALBI, albumin-bilirubin; APACHE, acute physiology and chronic health evaluation; APRI, aspartate aminotransferase-to-platelet ratio index; CRP, C-reactive protein; eGFR, estimated glomerular filtration rate; ICU, intensive care unit; MELD, model for end-stage liver disease; SAPS, simplified acute physiology score; SOFA, sequential organ failure assessment.…”

“…In some conditions the prognostic value is remarkably high. For example, in acute pancreatitis 145 ALBI proved superior to well-established scores such as SOFA (sequential organ failure assessment), SAPS (simplified acute physiology score)-II, APACHE (acute physiology and chronic health evaluation)-II, Ranson and Glasgow. In each of these instances authors have attempted to explain their results in terms of liver dysfunction associated with the particular condition described.…”