External Validation of Six Liver Functional Reserve Models to predict Posthepatectomy Liver Failure after Major Resection for Hepatocellular Carcinoma

Guo, Guangmeng; Lei, Zhengqing; Tang, Xuewu; Ma, Weihu; Si, Anfeng; Yang, Pinghua; Li, Qi; Geng, Zhimin; Zhou, Jiahua; Cheng, Zhangjun

doi:10.7150/jca.58726

Cited by 6 publications

(8 citation statements)

References 30 publications

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“…In our previous study, we validated and compared the predictive ability of 6 liver function reserve models for PHLF in patients with HCC after major hepatectomy. Our results revealed that although the ALBI score shows more accurate predictive ability, the areas under the receiver operating characteristic curves (AUROC) was only 0.64 ( 14 ), which indicated a limited accuracy. Therefore, development of a more accurate predictive model for PHLF is needed.…”

Section: Introductionmentioning

confidence: 76%

A Novel Nomogram for Predicting Postoperative Liver Failure After Major Hepatectomy for Hepatocellular Carcinoma

Lei

Cheng

et al. 2022

Front. Oncol.

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BackgroundPost-hepatectomy liver failure (PHLF) is the most common cause of mortality after major hepatectomy in hepatocellular carcinoma (HCC) patients. We aim to develop a nomogram to preoperatively predict grade B/C PHLF defined by the International Study Group on Liver Surgery Grading (ISGLS) in HCC patients undergoing major hepatectomy.Study DesignThe consecutive HCC patients who underwent major hepatectomy at the Eastern Hepatobiliary Surgery Hospital between 2008 and 2013 served as a training cohort to develop a preoperative nomogram, and patients from 2 other hospitals comprised an external validation cohort. Least absolute shrinkage and selection operator (LASSO) logistic regression was applied to identify preoperative predictors of grade B/C PHLF. Multivariable logistic regression was utilized to establish a nomogram model. Internal and external validations were used to verify the performance of the nomogram. The accuracy of the nomogram was also compared with the conventional scoring models, including MELD and ALBI score.ResultsA total of 880 patients who underwent major hepatectomy (668 in the training cohort and 192 in the validation cohort) were enrolled in this study. The independent risk factors of grade B/C PHLF were age, gender, prothrombin time, total bilirubin, and CSPH, which were incorporated into the nomogram. Good prediction discrimination was achieved in the training (AUROC: 0.73) and validation (AUROC: 0.72) cohorts. The calibration curve also showed good agreement in both training and validation cohorts. The nomogram has a better performance than MELD and ALBI score models.ConclusionThe proposed nomogram showed more accurate ability to individually predict grade B/C PHLF after major hepatectomy in HCC patients than MELD and ALBI scores.

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Section: Introductionmentioning

confidence: 76%

A Novel Nomogram for Predicting Postoperative Liver Failure After Major Hepatectomy for Hepatocellular Carcinoma

Lei

Cheng

et al. 2022

Front. Oncol.

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“…Therefore, many studies have focused on the prediction and diagnosis of ICP to enable earlier detection and prevention of ICP. 6,9,16,17,[27][28][29][30] Accordingly, serum levels of irsin, 25 vitamin D3, feutin-B, pregnancy-associated protein-A, and betatrophin have been used as novel biomarkers for the prediction and early diagnosis of ICP. 9,28,29 However, these biomarkers are not in the routine tests of maternal examinations.…”

Section: Discussionmentioning

confidence: 99%

“…Scores were calculated as follows: Aspartate aminotransferase (AST) À platelet ratio index (APRI) score = (AST/upper limit of normal 40 IU/L)/ platelet count Â 100, 13 MELD score = 3.78 Â ln (total bilirubin μmol/L) + 11.2 Â ln (INR) + 9.57 Â ln (creatinine mg/dL) + 6.4, 14 ALBI score = À0.085 Â (albumin g/L) + 0.66 Â (total bilirubin μmol/L). 16 The neutrophil/lymphocyte ratio (NLR) is calculated by dividing the absolute neutrophil count by the absolute lymphocyte count. Platelet/lymphocyte ratio (PLR) is obtained by dividing the absolute platelet count by the absolute lymphocyte count.…”

Section: Methodsmentioning

confidence: 99%

“…The following data were collected for both groups: age, gravida, parity, body mass index (BMI), hemoglobin level, platelet level, aspartate aminotransferase (AST), alanine aminotransferase (ALT), fasting bile acid level, APRI, MELD, ALBI score and NLR, PLR ratio in the first and at the time of diagnosis of ICP. Scores were calculated as follows: Aspartate aminotransferase (AST) − platelet ratio index (APRI) score = (AST/upper limit of normal 40 IU/L)/ platelet count × 100, 13 MELD score = 3.78 × ln (total bilirubin μmol/L) + 11.2 × ln (INR) + 9.57 × ln (creatinine mg/dL) + 6.4, 14 ALBI score = −0.085 × (albumin g/L) + 0.66 × (total bilirubin μmol/L) 16 …”

Section: Methodsmentioning

confidence: 99%

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Liver damage parameters and peripheral blood parameters for prediction and diagnosis of intrahepatic cholestasis in pregnancy

Obut,

Kından,

Ibanoğlu

et al. 2023

J of Obstet and Gynaecol

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ObjectiveIntrahepatic cholestasis of pregnancy (ICP) manifests in late pregnancy. Elevated serum bile acid is a diagnostic criterion: however, its measurement is troublesome. Prediction of ICP by blood markers is not established. Serum bile acid level is associated with liver damage and inflammation. We hypothesized that the following markers could predict the occurrence of ICP and have diagnostic value for it: Liver damage‐indicating scores (albumin–bilirubin [ALBI], Model for End‐Stage Liver Disease [MELD], aspartate aminotransferase‐to‐platelet ratio [APRI]) and inflammatory markers (platelet‐to‐lymphocyte ratio [PLR] and neutrophil‐to‐lymphocyte ratio [NLR]).MethodsEighty ICP patients and 200 controls were studied. The values of MELD, APRI, ALBI, PLR, and NLR were measured in the 1st trimester and at the time of diagnosis.ResultsPatients with ICP had significantly higher ALBI, MELD, and APRI scores both in the first trimester and at diagnosis. Multivariate logistic regression (MLR) showed that age, ALBI, MELD, and APRI scores were statistically significant (p < 0.05). By receiver operating characteristic (ROC) analysis, the sensitivity of MELD, ALBI, APRI, and NLR in the first trimester was 62%, 73%, 58%, and 29%, respectively, and MELD, ALBI, APRI, and PLR at diagnosis was 28%, 38%, 57%, and 8%, respectively, with a fixed false‐positive rate of 10%.ConclusionThis study has demonstrated the usability of the MELD, ALBI, and APRI scores in predicting and diagnosing ICP. They are easy to obtain and might be used in routine practice.

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“…Xiang et al reported a probability of 29.0% of severe PHLF in 186 patients with huge HCC [ 25 ]. Guo et al demonstrated that 13.8% patients experienced PHLF of all grades after major hepatectomy in a total of 745 patients [ 26 ]. In the present study, based on the experience of two centers over a period of 5 years, we reported a double PHLF grade B–C rate after hepatectomy in a large cohort of 611 patients with huge HCC.…”

Section: Discussionmentioning

confidence: 99%

An mALBI-Child–Pugh-based nomogram for predicting post-hepatectomy liver failure grade B–C in patients with huge hepatocellular carcinoma: a multi-institutional study

Zhou

et al. 2022

World J Surg Onc

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Objective Post-hepatectomy liver failure (PHLF) is a severe complication in patients with hepatocellular carcinoma (HCC) who underwent hepatectomy. This study aims to develop a nomogram of PHLF grade B–C in patients with huge HCC (diameter ≥ 10 cm). Methods We retrospectively collected clinical information of 514 and 97 patients who underwent hepatectomy for huge HCC at two medical centers between 2016 and 2021. Univariate and multivariate analysis were carried out to screen the independent risk factors of PHLF grade B–C, which were visualized as a nomogram. Results Three Hundred Forty Three Thousand One Hundred Seventy One and 97 HCC patients were included in the training cohort, internal validation cohort, and external validation cohort, with probabilities of PHLF grade B–C of 15.1%, 12.9%, and 22.7%, respectively. Pre-operative modified albumin-bilirubin (mALBI) grade (p < 0.001), Child–Pugh classification (p = 0.044), international normalized ratio (INR) (p = 0.005), cirrhosis (p = 0.019), and intraoperative blood loss (p = 0.004) were found to be independently associated with PHLF grade B–C in the training cohort. All the five independent factors were considered in the establishment of the nomogram model. In the internal validation cohort and external validation cohort, the area under receiver operating characteristic curve for the nomogram in PHLF grade B–C prediction reached 0.823 and 0.740, respectively. Divided into different risk groups according to the optimal cut-off value, patients in the high-risk group reported significantly higher frequency of PHLF grade B–C than those in the low-risk group, both in the training cohort and the validation cohort (p < 0.001). Conclusions The proposed noninvasive nomogram based on mALBI-Child–Pugh and three other indicators achieved optimal prediction performance of PHLF grade B–C in patients with huge HCC.

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External Validation of Six Liver Functional Reserve Models to predict Posthepatectomy Liver Failure after Major Resection for Hepatocellular Carcinoma

Cited by 6 publications

References 30 publications

A Novel Nomogram for Predicting Postoperative Liver Failure After Major Hepatectomy for Hepatocellular Carcinoma

A Novel Nomogram for Predicting Postoperative Liver Failure After Major Hepatectomy for Hepatocellular Carcinoma

Liver damage parameters and peripheral blood parameters for prediction and diagnosis of intrahepatic cholestasis in pregnancy

An mALBI-Child–Pugh-based nomogram for predicting post-hepatectomy liver failure grade B–C in patients with huge hepatocellular carcinoma: a multi-institutional study

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