The value of prealbumin in predicting post hepatectomy liver failure for patients with hepatocellular carcinoma undergoing major hepatectomy

Abstract

Post hepatectomy liver failure (PHLF) poses a significant threat to the prognosis of patients with hepatocellular carcinoma (HCC), particularly those undergoing major hepatectomy. The present research endeavors to clarify the influence of prealbumin on the development of PHLF in HCC patients who have undergone major hepatectomy. Patients with HCC who have undergone major hepatectomy were included. Based on the ROC curve, the optimal cut-off value for prealbumin was determined and patients were divided into two groups. Univariate and multivariate logistic analyses were conducted to identify risk factors for PHLF in HCC patients. Furthermore, the predictive ability of PHLF was also evaluated. 466 patients were included, among whom 98 (21%) developed PHLF. Compared with the high prealbumin group, patients in the low prealbumin group had significantly higher proportions of cirrhosis, portal hypertension, intraoperative blood loss, and transfusion, as well as a higher incidence of PHLF (12.3% vs. 23.5%, P = 0.011). Multivariate analysis revealed that prealbumin is a risk factor for PHLF (HR 1.446, 95%CI 1.091-2.369, P = 0.015), but it is not a risk factor for severe PHLF (HR 1.183, 95%CI 0.584-2.692, P = 0.289). However, the comprehensive indicator, prealbumin-bilirubin (preALBI), is not only a risk factor for PHLF but also severe PHLF. Furthermore, its predictive performance is significantly higher than that of other related indicators (all P < 0.05). Patients with low prealbumin levels require perioperative protocols: precise resection control, liver volume assessment, and PHLF prevention monitoring.

Keywords: Hepatocellular carcinoma; Major hepatectomy; Post hepatectomy liver failure; Prealbumin; Prealbumin-bilirubin.

Fig. 1

Comparisons of the area under the receiver operating character curves for post-hepatectomy liver failure (A) and severe post-hepatectomy liver failure (B) stratified by the prealbumin, ALB, ALBI, preALBI and Child-Pugh grade. Abbreviations: ALB, albumin; preALB, prealbumin; ALBI, albumin-bilirubin; preALBI, prealbumin-bilirubin; C-P, Child-Pugh.