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A simple, noninvasively determined index predicting hepatic failure following liver resection for hepatocellular carcinoma
Author(s) -
Ichikawa Tsuyoshi,
Uenishi Takahiro,
Takemura Shigekazu,
Oba Kazuki,
Ogawa Masao,
Kodai Shintaro,
Shinkawa Hiroji,
Tanaka Hiromu,
Yamamoto Takatsugu,
Tanaka Shogo,
Yamamoto Satoshi,
Hai Seikan,
Shuto Taichi,
Hirohashi Kazuhiro,
Kubo Shoji
Publication year - 2009
Publication title -
journal of hepato‐biliary‐pancreatic surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.63
H-Index - 60
eISSN - 1868-6982
pISSN - 0944-1166
DOI - 10.1007/s00534-008-0003-4
Subject(s) - hepatocellular carcinoma , medicine , cirrhosis , gastroenterology , ascites , hepatic fibrosis , indocyanine green , pleural effusion , univariate analysis , hepatectomy , surgery , multivariate analysis , resection
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.