Preoperative aspartate aminotransferase-to-platelet-ratio index as a predictor of posthepatectomy liver failure for resectable hepatocellular carcinoma

Abstract

Purpose: This study aimed to investigate the efficacy of preoperative aspartate aminotransferase-to-platelet-ratio index (APRI) score to predict the risk of posthepatectomy liver failure (PHLF) in patients with hepatocellular carcinoma (HCC) after liver resection, and to compare the discriminatory performance of the APRI with the Child-Pugh score, model for end-stage liver disease (MELD) score, and albumin-bilirubin (ALBI) score.

Patients and methods: A total of 1,044 consecutive patients with HCC who underwent liver resection were enrolled and studied. Univariate and multivariate analyses were performed to investigate risk factors associated with PHLF. Predictive discrimination of Child-Pugh, MELD, ALBI, and APRI scores for predicting PHLF were assessed according to area under the ROC curve. The cutoff value of the APRI score for predicting PHLF was determined by ROC analysis. APRI scores were stratified by dichotomy to analyze correlations with incidence and grade of PHLF.

Results: PHLF occurred in 213 (20.4%) patients. Univariate and multivariate analyses revealed that Child-Pugh, MELD, ALBI, and APRI scores were significantly associated with PHLF. Area under the ROC analysis revealed that the APRI score for predicting PHLF was significantly more accurate than Child-Pugh, MELD, or ALBI scores. With an optimal cutoff value of 0.55, the sensitivity and specificity of the APRI score for predicting PHLF were 72.2% and 68.0%, respectively, and the incidence and grade of PHLF in patients with high risk (APRI score >0.55) was significantly higher than in the low-risk cohort (APRI score <0.55).

Conclusion: The APRI score predicted PHLF in patients with HCC undergoing liver resection more accurately than Child-Pugh, MELD, or ALBI scores.

Keywords: Child–Pugh score; albumin-bilirubin score; aspartate aminotransferase-to-platelet ratio index; hepatocellular carcinoma; liver resection; model for end-stage liver disease score; posthepatectomy liver failure.

Figure 1

ROC curves of APRI, Child–Pugh, MELD, and ALBI scores for predicting PHLF. Notes: (A) Entire cohort of patients. (B) Patients positive for HBsAg and HBV DNA >2,000 IU/mL. (C) Patients positive for HBsAg and HBV DNA ≤2,000 (IU/mL). (D) Patients with cirrhosis. (E) Patients without cirrhosis. (F) Patients with major liver resection. (G) Patients with minor liver resection. (H) Patients with intraoperative blood loss ≥400 (mL). (I) Patients with intraoperative blood loss <400 mL. Area under the curve: (A) 0.743 for APRI vs 0.562 for Child–Pugh, 0.647 for MELD, and 0.662 for ALBI; (B) 0.746 vs 0.572, 0.659, and 0.681; (C) 0.699 vs 0.554, 0.614, and 0.661; (D) 0.732 vs 0.585, 0.641, and 0.677; (E) 0.729 vs 0.533, 0.638, and 0.640; (F) 0.718 vs 0.558, 0.634, and 0.648; (G) 0.758 vs 0.563, 0.684, and 0.669; (H) 0.743 vs 0.538, 0.638, and 0.641; (I) 0.729 vs 0.574, 0.656, and 0.667, respectively. Abbreviation: HBsAg, hepatitis B surface antigen; HBV, hepatitis B virus MELD, model for end-stage liver disease; ALBI, albumin–bilirubin; APRI, aspartate aminotransferase-to-platelet-ratio index; PHLF, posthepatectomy liver failure.

Figure 2

Correlations between risk cohorts of APRI score and incidence and grade of PHLF. Notes: (A) Entire cohort of patients. (B) Patients positive for HBsAg and HBV DNA >2,000 IU/mL. (C) Patients positive for HBsAg and HBV DNA ≤2,000 IU/mL. (D) Patients with cirrhosis. (E) Patients without cirrhosis. (F) Patients with major liver resection. (G) Patients with minor liver resection. (H) Patients with intraoperative blood loss ≥400 mL. (I) Patients with intraoperative blood loss <400 mL (incidence, P<0.001 for all [χ²-test]; grade, P<0.001 for all [Kruskal-Wallis H-test]). Abbreviations: HBsAg, hepatitis B surface antigen; HBV, hepatitis B virus; APRI, aspartate aminotransferase-to-platelet-ratio index; PHLF, posthepatectomy liver failure.